HX641 68433 
RG1 36  K75  1 91 9         Birth  control  in  its 


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Knopf,  S.  Adolphus 

Birth  Control  1919. 


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BIRTH  CONTROL 

IN  ITS   MEDICAL,   SOCIAL,    ECONOMIC 
AND   MORAL  ASPECTS 


BY 

S.  ADOLPHUS  KNOPF,  M.  D. 

P)-ofessor  of  Medicine,  Department  of  Phthisiotherapy,  at  the  Neic  York  Post- 
Graduate  Medical  School  and  Hospital;  Visiting  Phtisician  to  the  Riverside 
Hospital-Sanatorium   of   the   Health   Department   of   the   City   of 
New  York;  formerly  Captain  in  the  Medical  Corps, 
U.  8.  Army 


With  the  discussion  by  Drs.   Ira  S.   Wile,   J.   H.  Laxdis, 

W.  L.  Holt,  Louis  I.  Dublin,  John  W.  Teask, 

and  the  closing  remarks  by  Dr.  Knopf. 


1919 
SECOND  EDITION 


Revised  by  the  Author  and  reprinted  with  his  permission  by  the 

NEW  YORK  ^\TOMEN'S  PUBLISHING  CO.,  INC., 

104  Fifth  Avenue,  New  York. 


Birth  Control  in  Its  Medical,  Social,  Eco- 
nomic, and  Moral  Aspects 

Bj  S.  Adolphus  Knopf,  M.D.  (Pans  and  New  York) 

Professor  of  Medicine^  Department  of  PhtMsiotherapy,  at  the  New  York 

Post-Graduate  Medical  Schoov   and  Hospital;    Visiting   Physician    to    tlie 

Riverside  Hospital-Sanatorium  of  the  Health  Department  of  the  City  of 

Nexv  York;  Formerly  Captain  in  the  Medical  Corps,  U.  S.  Army. 

Preface  to  the  Second  Edition. 

The  first  edition  of  my  lecture  on  Birth  Control  in  Its  Medical,  Social, 
Economic,  and  Moral  Aspects  having  been  complete!}'  exhausted,  I  have 
been  requested  to  permit  the  printing  of  a  second  edition.  This  lecture  was 
delivered  for  the  first  time  in  October,  1916,  before  the  American  Public 
Health  Association  and  has  since  been  read  a  number  of  times  before 
medical,  legal,  church,  and  civic  organizations.  The  question  may  now 
arise  whether  it  is  up  to  date  after  the  fearful  worM  war  in  which  our  own 
country  finally  had  to  participate  so  that  humanity  might  be  safe  from  the 
tyranny  and  oppression  of  autocratic  rulers  and  governments.  The  Avar, 
with  its  sequel  of  a  terrible  influenza  plague,  has  probably  cost  from  twelve 
to  fifteen  million  lives,  and  the  casual  observer  might  say  verily  no  thought 
should  now  be  given  to  birth  control,  for  we  must  replace  the  lost  population 
and  particularly  the  lost  man  power. 

I  have  discussed  the  various  aspects  of  birth  control  in  my  paper,  and 
the  remarks  made  by  Assistant  Surgeon  General  Trask  df  the  U.  S.  Public 
Health  Service,  reproduced  in  this  pamphlet  on  page  27,  ansAver  all  argu- 
ments for  uncontrolled  increase  of  population  during  Avar  times  and  there- 
after. Our  mobilization  experience  has  shown  us  that  one-third  of  the 
millions  of  men  who  were  examined  were  physically  unfit  to  sei-ve  in  the 
army,  and  I  venture  to  say  that  if  an  examination  of  our  female  population 
would  have  been  made,  the  proportion  of  women  mentally  and  physically 
unfit  to  be  mothers  might  have  been  equally  as  great.  In  connection  with 
this  I  Avish  to  emphasize  Avhat  I  said  in  the  first  edition  of  this  pamphlet, 
namely,  that  my  appeal  is  not  for  reducing  the  population  but  for  increas- 
ing its  A'igor  by  reducing  the  number  of  the  physicall}',  mentally,  and  morally 
unfit  and  adding  to  the  number  of  the  physically  strong,  mentally  sound, 
and  higher  morally  developed  men  and  Avomen. 

On  June  9th  of  tins  year,  before  the  American  Academy  of  Medicine,  I 
delivered  an  address  entitled  "The  Tuberculosis   Problem  After  the  World 


4  Birth  Control 

War,"  in  which  I  gave  some  statistics  of  the  fearful  prevalence  of  tubercu- 
losis in  Europe  at  this  time  (Medical  Record,  July  26,  1919).  What 
France  and  Belgium  have  suffered  from  this  disease  is  too  well  known  to 
need  repetition  here,  but  still  more  terrible  are  the  reports  which  came  to 
me  from  Italy,  Greece,  and  Servia  by  no  less  an  authority  than  Col.  Homer 
Folks,  former  Charity  Commissioner  of  the  city  of  New  York,  who  had  just 
returned  from  an  extended  visit  to  Italy,  Greece,  and  Servia,  where  on  behalf 
of  the  Red  Cross  he  had  investigated  the  general,  economic,  and  sanitary 
conditions  of  these  stricken  countries.  An  additional  report  has  come  to 
me  from  Dr.  Rosalie  Slaughter  Morton,  that  brave  woman  who  without 
compensation  served  as  a  medical  officer  during  the  past  years  to  the  civilian 
and  military  population  of  stricken  Servia.  To  judge  from  these  reports 
the  tuberculosis  situation  is  exceedingly  grave  in  all  these  countries.  Col. 
Folks  reports  an  increase  of  tuberculosis  mortality  of  17  per  cent  through- 
out Italy  from  1914  to  1916,  and  a  further  increase  in  the  cities  of  12  per 
cent  in  1917.  In  Greece  matters  seem  to  be  even  worse.  In  Athens  before 
1914  there  was  a  death  rate  of  1  in  6  from  tuberculosis ;  now,  owing  to  war 
conditions,  this  has  undoubtedly  considerably  increased,  although  exact 
statistics  are  not  available. 

In  Servia,  which  held  the  enemy  forces  at  bay  for  fourteen  months,  the 
people  have  perhaps  suffered  from  tuberculosis  as  much  as  any  country  of 
the  Allied  or  Central  powers.  Col.  Folks  estimates  that  the  Servian  popu- 
lation is  now  25  per  cent  less  than  it  was  at  the  outbreak  of  the  war.  The 
mortality  from  tuberculosis  in  old  Servia,  i.e.,  the  northern  part,  including 
the  cit^"  of  Belgrade,  was  already  high  before  the  war^ — 324  per  100,000  in 
1911.  In  Belgrade  in  1912  it  was  720  per  100,000;  in  1917,  according  to 
an  Austrian  report,  it  had  risen  to  1,483  per  100,000. 

Dr.  Rosalie  Slaughter  Morton,  who  had  recently  returned  for  a  brief  visit 
from  Servia,  described  the  tuberculosis  situation  to  me  personally  as  simply 
appalling.  Men,  women,  and  children  were  dying  by  the  thousands  from  this 
disease.  Out  of  14,000  Servian  prisoners  who  were  returned  to  their  home 
country  after  the  armistice,  6,000  had  contracted  tuberculosis,  and  in  the 
new  Czecho-Slovac  republic  conditions  seem  to  be  fully  as  bad. 

The  question  must  now  be  asked  should  these  tuberculous  people  not  yet 
cured  and  man}^  of  whom  are  too  far  advanced  to  ever  become  cured,  pro- 
create children.'^  Should  they  not  rather  be  taught  birth  control  and  not 
people  the  world  with  additional  invalids,  burdens  to  themselves  and  the 
community.^  I  took  up  this  question  in  my  oi^ginal  article  in  1916,  and  my 
views  were  endorsed  at  that  time  by  Dr.  J.  N.  Hurty  of  Indianapolis  (see 
page  26),  but  in  my  address  on  The  Tuberculosis  Problem  After  the  World 
War  I  stated  that  birth  control,  particularly  in  countries  where  there  are 
still  thousands  of  people  with  little  food,  poor  shelter,  and  insufficient  cloth- 


Birth  Control  5 

ing,  would  be  absolutely  essential  in  order  to  combat  this  world  plague.  I 
do  not  stand  alone  with  this  view.  All  students  of  the  tuberculosis  problem, 
and  the  social  problems  in  general  that  confront  us  in  the  war-stricken 
countries,  are  of  the  same  opinion.  In  a  remarkable  letter  which  I  i-epro- 
duced  in  my  address  before  the  American  Academy  of  Medicine  from  tbe 
Journal  of  the  American  Medical  Association  of  April  19,  1919,  Dr.  C.  K. 
Millard,  Health  Officer  of  Leicester,  England,  writes  as  follows : 

"The  question  of  the  birth  rate  is  intimately  bound  up  with  that  of  birtli 
control.  It  is  unfortunate  that  scientific  study  of  the  subject  has  been 
hitherto  neglected.  Owing  to  the  supposed  moral  stigma  many  had  tabooed 
it,  and  it  is  only  quite  recently  that  unbiased  discussion  had  become  possible. 
The  subject  is  of  special  interest  and  importance  at  the  present  day, 
through  conditions  arising  out  of  the  war.  In  many  parts  of  Europe  the 
social  conditions  of  the  people,  with  starvation  staring  them  in  the  face, 
without  proper  clothing  or  shelter,  with  civilization  itself  broken  down, 
are  deplorable  in  the  extreme.  It  appears  eminently'  desirable  that  rigid 
birth  control  should  be  practiced  in  those  countries,  and  probably  in  others 
also,  if  acute  maternal  suffering  and  terrible  infant  mortality  are  to  be 
avoided.  The  best  things  for  the  people  of  those  countries  to  do  is  tempo- 
rarily to  stop  having  children,  so  far  as  it  can  be  avoided,  until  happier 
and  more  prosperous  times  arrive.  It  seems  to  be  taken  for  granted  in 
most  countries  that  rapid  increase  in  population  is  needed  in  the  national 
interest,  and  that  a  stationary  population  would  be  disastrous.  No  doubt 
this  sentiment  is  really  based  on  militarist  considerations,  and  in  the  past, 
when  such  considerations  were  vital,  it  might  have  been  wise  to  encourage  it. 
But  now,  with  the  inteniational  situation  fundamentally  altered,  and  with 
the  League  of  Nations  (whose  special  function  it  would  be  to  safeguard 
the  nations  with  small  population),  it  is  time  to  reconsider  our  attiude. 
International  competition  in  birth  rates  is  to  be  avoided,  just  as  was  com- 
petition in  aiinaments.  There  are  certain  countries  which  are  already 
"saturated"  as  regards  population,  in  the  sense  that  any  further  increase 
would  not  tend  to  increase  the  happiness  or  prosperity  of  the  inhabitants. 
Wherever  that  point  has  arrived,  or  is  nearly  at  hand,  birth  control  must 
be  regarded  as  the  proper  remedy,  and  as  greatly  preferable,  in  most  cases, 
to  emigration.  The  case  of  England  is  complicated  by  the  fact  that  she  is 
the  mother  country  of  an  empire.  Many  people  would  agree  that  the  popu- 
lation of  the  British  Isles  is  large  enough,  but  the}'  wanted  to  see  her  great 
colonies  filled  up  with  an  all  British  population.  No  doubt  this  is  very 
patriotic,  from  the  standpoint  of  conditions  before  the  war;  but  from  the 
point  of  view  of  the  League  of  Nations  they  ought  to  regard  their  colonies 
as  the  natural  outlet  for  the  surplus  population  of  all  European  countries. 
It  is  so  necessary  for  the  peace  of  Europe  that  such  an  outlet  should  exist 


^  Birth  Control 

that  they  need  not  be  in  any  Imrry  to  see  those  territories  filled  up.  As  to 
the  question  of  practical  methods,  physicians  have  not  o-iven  it  sufficient 
attention  to  enable  them  to  speak  very  authoritatively.  Certain  physicians, 
with  obviously  a  strong  bias  on  moral  grounds,  have  condemned  all  methods 
as  highly  injurious,  but  the  bishops  in  a  special  report  on  this  subject 
presented  to  the  Pan-Anglican  Conference  in  1908,  have  seized  an  isolated 
medical  opinion  of  this  kind  and  used  it  as  though  it  were  the  considered 
verdict  of  the  medical  profession. 

"To  ascertain  what  is  the  real  opinion  of  the  profession  of  the  present 
day  Dr.  Millard  has  recently  issued  a  questionnaire  to  medical  practition- 
trs,  and  from  some  eighty  rephes  received  he  is  quite  satisfied  that  the  great 
majority  of  the  profession  does  not  regard  birth  control  as  necessarily 
injurious."     (London  Letter,  March  27,  1919,  to  Jour,  of  the  A.  M.  A.) 

A  leading  statesman  and  politician  of  England,  Mr.  Harold  Cox,  before 
the  English  .National  vB'irthrate  Connmission,  recently  gave  irrefutable 
evidence  of  the  great  need  of  birth  control  at  this  very  time,  even  in  England 
and  Wales,  countries  which  in  comparison  with  France,  Belgium,  Italy,  and 
the  Balkan  states,  have  suffered  comparatively  little  from  tuberculosis  or 
other  epidemics,  as  a  consequence  of  the  war.  Mr.  Cox's  statements  are 
summarized  as  follows  in  the  Journal : 

"In  opposition  to  the- endowment  of  motherhood  by  the  State,  Mr.  Harold 
Cox  pointed  out  that  the  population  of  England  and  Wales  doubled  in  the 
sixty  years  that  ended  in  1911.  Suppose  that  rate  of  increase  were 
continued  indefinitely,  then  in  the  year  2201,  the  population  of  England  and 
Wales  alone  would  be  2,295,000,000.  No  further  argument  was  needed  to 
prove  that  the  rate  of  increase  in  the  population  must  decline  as  the  volume 
grows.  The  rate  could  only  be  reduced  either  by  diminishing  the  birth  rate 
or  by  increasing  the  death  rate.  If  birth  control  were  in  itself  immoral,  it 
would  still  be  immoral  when  the  population  had  reached  such  a  volume  that 
a  reduced  rate  of  increase  became  absolutely  necessary.  A  high  infantile 
death  rate  was  the  almost  invariable  accompaniment  of  a  high  birth  rate. 
Thousands  of  children  were  fated  only  to  live  a  few  weeks  or  a  few  months. 
This  involved  a  vast  waste  of  human  effort.  In  the  East  the  waste  of 
women's  bodies  and  of  infant  life  was  even  more  appalling.  Both  in  India 
and  in  China,  out  of  every  thousand  children  bora  often  more  than  500  died. 
The  socialist  proposal  to  give  a  state  subsidy  to  every  woman  who  produces 
a  child  would  only  increase  the  evil.  Children  reared  by  subsidized  parents 
would  probably  lounge  through  life  leaning  on  the  state.  A  few  years  ago 
the  Germans  established  an  imperial  grant  to  mothers  who  suckled  their 
babies.  Last  year's  Local  Government  Board  report  on  infant  welfare  in 
Germany   says :      "It   is    recorded    from   a   large   number   of    centers    that 


Birth '.Control  7 

mothers  discontinue  breast-feeding  immediately  the  imperial  allowance  ceases, 
regardless  of  the  well-being  of  their  infants."  It  would  be  futile  to  deal  with 
the  German  peril  by  means  of  what  might  be  called  a  cradle  competition.  In 
such  a  contest  we  must  inevitably  be  beaten,  because  Germany  started  the 
race  with  a  much  largei-  volume  of  population.  England  at  the  present 
moment  was  over-populated.  Doubtless  considerable  improvement  would  be 
effected  if  our  industries  could  be  established  in  garden  cities.  But  if  this 
process  were  carried  to  the  point  of  giving  all  our  overcrowded  millions  a 
quasi-rural  surrounding,  there  would  be  no  real  country  left.  Our  island  was 
too  small  to  afford  possibilities  for  a  full  life  to  all  the  millions  now  crowded 
on  it.  He  therefore  welcomed  the  decline  in  population,  and  hoped  it  would 
continue."  (London  Letter,  May  28,  1919,  to  the  Journal  of  the  A.  M.  A., 
Vol.  72,  No.  26,  1919.) 

To  the  strong  statements  on  the  advisability  of  birth  control  made  on 
the  one  hand  by  so  distinguished  an  authority  as  Dr.  Millard,  and  on  the 
other  by  the  political  economist,  Mr.  Cox,  I  may  finally  add  the  opinion  of 
an  eminent  English  divine,  the  Right  Rev.  H.  Russell  Wakefield,  D.D., 
Bishop  of  Birmingham,  President  Council  of  Public  Morals,  and  Chairman 
National  Birth  Rate  Commission.  I  quote  from  the  London  Times  of  April 
8,  1919,  and  "The  Medical  Critic  and  Guide"  of  July,  1919,  which  credit 
the  revei-end  gentleman  with  having  said  that  "The  cry  of  many  social 
reformers  was  for  a  greatly  increased  birth  rate,  but  what  a  nation  needed 
most  was  not  an  unlimited  number  of  citizens,  but  a  sufficient  number  of  the 
best  quality.  Morally,  as  well  as  eugenically,  it  was  right  for  people  in 
certain  circumstances  to  use  harmless  means  to  control  the  birth  rate. 

"The  most  unsatisfactory  feature  in  regard  to  this  matter  was  that  child- 
bearing  was  prolific,  generally  speaking,  only  in  the  very  classes  in  which 
the  children  very  often  did  not  get  a  fair  opportunity  of 'life,  while  in  the 
sections  of  the  population  where  there  were  good  prospects  of  ensuring  a 
healthy  upbringing  control  was  carefully  exercised. 

"It  was  contended,  by  objectors  to  birth  control,  that  the  object  of 
marriage  being  the  production  of  children,  preventive  measures  were  neceb- 
sarily  wrong.  The  great  Roman  Catholic  Church,  with  its  magnificent 
decisiveness  of  no  compromise  except  one,  and  the  Anglican  Bishops  had  so 
far  taken  the  same  line.  The  Jewish  Church  was  also  emphatic  on  the  mat- 
ter, but  the  Nonconformist  Churches  had  not  spoken  formally.  The  reply 
to  the  argument  used  might  be  that  the  procreation  of  children  was  not  the 
only  object  of  matrimony,  and  there  was  surely  a  dishonoring  of  that  very 
object  to  have  children  bom  when  not  wished  for  by  both  parents. 

"Had  not  the  sexual  association  of  married  people  a  spiritual  meaning 
which  must  be  placed  first  in  all  definitions  of  it.f*    It  was  surely  the  culminat- 


8  Birth  Control 

ing  expression  of  the  love  of  the  two  who  had  become  one  flesh.  It  brought 
with  it  the  creation  of  a  child  which  was  the  combination  of  the  two  natures, 
but  it  need  not  be  an  imperfect  union  if  on  occasion,  for  high  and  pure 
motives,  there  was  a  sacrifice  of  this  particular  result  of  married  love." 

What  the  distinguished  economist,  Mr.  Cox,  stated  concerning  the  present 
and  future  condition  of  England  and  Wales  is  to  a  large  extent  applicable 
to  the  United  States,  although  it  can  hardly  be  said  that  at  this  moment  the 
United  States  are  over-populated.  However,  if  the  increase  in  yjopulation 
and  additional  immigration  continues  in  the  United  States  as  it  has  during 
ihe  past  fift}'  years,  there  is  a  great  likelihood  that  a  condition  of  over- 
population will  be  reached  within  two  or  three  generations  from  now,  and 
in  the  meantime  the  result  of  an  uncontrolled  birth  rate  among  the  physi- 
cally, mentally,  and  morally  unfit  will  continue  with  its  trail  of  crime, 
suffering,  and  increased  burdens  to  indi^adual  families  and  the  community 
at  large. 

To  any  unbiased  mind  it  must  be  evident  that  our  very  experience,  before, 
during,  and  after  this  world  war,  answers  all  objections  to  judicious  birth 
control  in  its  medical,  social,  economic,  moral,  and  even  spiritual  aspects. 
Wliat  this  world  Heeds  now — after  the  fearful  catastrophe  which  Avas  started 
by  a  nation  in  which  unlimited  procreation  among  rich  and  poor,  the 
educated  and  the  uneducated,  the  well  and  the  sick,  was  not  only  encouraged 
but  oflficially  rewarded — is  not  a  greater  but  a  better  population.  The 
empire  which  sought  world  dominion  and  the  enslavement  of  other  nations 
had  the  highest  birth  rate  and  the  most  rapid  growth  of  population,  and 
yet,  it  was  France,  which  had  by  its  birth  control  produced  not  as  many  but 
better  soldiers,  which  withstood  the  most  terrific  onslaughts  of  the  enemy's 
hordes.  The  generals  of  the  German  army  sacrificed  their  soldiers  en 
masse  in  close  columns ;  it  would  seem  that  these  military  leaders  felt  that 
the  empire  had  produced  such  great  masses  of  men  that  they  did  not  need 
to  be  so  sparing  and  economical  with  human  life. 

The  world  needs  now  and  for  all  the  future  the  very  best  kind  of  men  and 
women,  not  servile  masses  blindly  obej^ing  war-drunk  monarchs  and  mili- 
taristic rulers,  not  a  mass  of  weaklings,  bound  to  succumb  before  reaching 
man-  or  womanhood,  unable  to  serve  or  to  produce.  We  need  children,  but 
only  such  as  are  welcome  to  the  home  which  physically,  mentally,  and 
morally  sound  parents  have  provided.  The  parents  being  economicalh' 
situated  so  as  to  be  able  to  give  enough  food,  enough  clothing,  enough 
playtime  to  their  children  and  live  in  comfort  and  enjoy  life  themselves. 
The  state  will  then  be  able  to  provide  enough  educational  facilities  for 
children,  and  child  labor  will  be  done  away  with.  Parents  and  children  of 
the  present  generation  should  receive  a  training  and  education  that  with 
the  help  of  a  wise  government  and  enlightened  statesmen  should  be  instru- 


Birth  Control  9 

mental  to  create  a  future  race  of  true  men  and  women,  physically,  mentally, 
and  morally  sound,  spiritually  hif^h  minded,  images  of  their  creatoi-. 

Now,  as  a  final  argument,  I  should  like  to  add  some  interesting  figures 
from  a  recently  published  monograph  entiHed  "The  Mathematical  Theory  of 
Population,  of  Its  Character  and  Fluctuations,  and  of  the  Factors  Which 
Influence  Them."  (Melbourne,  Commonwealth  Bureau  of  Census  and  Sta- 
tistics, 1917),  by  Mr.  G.  H.  Knibbs,  the  statistician  of  the  Commonwealth 
of  Australia. 

Some  significant  facts  and  estimates  in  regard  to  the  present  and  future 
population  of  the  earth  are  given  by  Mr.  Knibbs.  He  puts  the  population 
of  the  earth  for  the  year  1914  at  1,649,000,000,  or  about  thirty-nine  million 
in  excess  of  the  estimate  for  1910  by  Jaraschek,  the  French  statistician. 
The  annual  rate  of  increase  in  the  world's  population  for  the  five-year 
period  1906  to  1911,  Knibbs  estimates  at  0.01159,  or  1.159  per  cent. 
Should  such  a  rate  of  increase  be  continued,  it  must  result  in  a  severe  strain 
on  the  resources  of  Nature.  Knibbs  asks  whether  medical  men  in  future 
will  take  a  stand  in  favor  of  so  colossal  a  population  that  the  masses  will 
scarcely  be  provided  with  the  bare  necessaries  of  lite,  or  .whether  they  will 
favor  birth  control  and  a  limitation  of  birth  in  such  a  manner  that  the 
population  of  the  earth  shall  never  be  greater  than  can  be  adequately  pro- 
vided for  on  a  high  plane  of  physical,  mental  and  moral  exist ence.'^ 

This  interesting  report  was  copied  by  the  Journal  of  the  American 
Medical  Association,  in  its  issue  of  November  22,  1919,  which  means  that  it 
may  have  been  read  by  50,000  American  physicians.  Mr.  Knibbs'  report 
has  doubtless  reached  not  only  Great  Britain  and  her  colonies  but  also  the 
now  sorely  afflicted  countries  of  Europe.  May  our  own  physicians  and 
statesmen  as  Avell  as  those  of  Europe  realize  the  importance  of  such  figures 
and  awake  to  the  moral  responsibility  to  save  future  generations  from  famine 
and  disaster. 

S.  Adolphus  Knopf,  M.D. 

New  York,  December  1,  1919. 


Birth  Control  In  Its  Medical,  Social,  Eco- 
nomic, and  Moral  Aspects 

S.  Adolphus  Knopf,  M.  D.  (Paris  and  New  York), 

Professor  of  Medicine,  DepartTnent  of  Phthisiotherapy,  at  the  New  York 
Post-Graduate  Medical  School  and  Hospital;  Visiting  Physician  to  the 
Riverside  Hospital-Sanatorium  of  the  Health  Department  of  the  City 
of  New  York;  Formerly  Captain  in  the  Medical  Corps,  U.  S.  Army. 


WHEN  at  this  very  moment, 
October  27,  1916,  across 
the  sea  in  Europe  the  best 
blood  of  the  nations  which  were  here- 
tofore considered  the  most  enhght- 
ened,  cultured,  and  civilized,  is  daily 
being  shed  and  hundreds  of  thous- 
ands of  young  men  in  the  prime  of 
life  sacrificed  to  the  Moloch  of  war, 
it  must  seem  a  hazardous  undertak- 
ing to  talk  of  birth  control,  which 
means  artificial  birth  limitation  and 
by  some  superficial  observers  is  desig- 
nated as  race  suicide.  I  trust,  how- 
ever, that  before  I  arrive  at  the  end 
of  my  paper,  I  will  have  convinced 
you  that  the  object  of  my  appeal  is 
not  a  plea  for  reducing  the  popula- 
tion but  for  increasing  its  vigor  by 
reducing  the  number  of  the  physi- 
cally, mentally,  and  morally  unfit  and 
adding  to  the  number  of  physically 
strong,  mentally  sound,  and  higher 
morally  developed  men  and  women. 

In  accordance  with  the  program 
outlined,  I  will  deal  first  with  the 
medical  and  sanitary  aspects  of  the 
subject.  No  one  will  deny  that  we 
occasionally  come  across  a  family, 
well-to-do  and  intelligent,  where  the 
parents  by  reason  of  unusual  vigor, 
and   particularly   by    reason   of    the 


physical  strength  of  the  mother,  have 
been  able  to  rear  a  large  number  of 
children.  In  some  instances  all  have 
survived  and  have  grown  up  to  be 
healthy  and  vigorous,  but  these  in- 
stances are  rare  and  are  becoming 
more  and  more  so  every  day.  On  the 
other  hand,  large  families,  that  is  to 
say,  numerous  children  as  the  issue 
of  one  couple,  among  the  ignorant, 
the  poor,  the  underfed  and  badly 
housed,  the  tuberculous,  the  degen- 
erate, the  alcoholic,  the  vicious,  and 
even  the  mentally  defective,  is  an 
everyday  spectacle.  It  is  well  known 
to  every  general  practitioner  whose 
field  of  activity  lies  among  the  poor 
and  the  above  mentioned  classes,  that 
the  infant  mortality  among  these  is 
very  great.  The  same  holds  true  of 
the  mortality  of  school  children  com- 
ing from  large  families  among  these 
classes  of  the  population. 

Concerning  tuberculosis,  with 
which,  by  reason  of  many  years'  ex- 
perience, I  am  perhaps  more  familiar 
than  with  other  medical  and  social 
diseases,  let  me  relate  the  interesting 
fact  that  a  carefully  taken  history  of 
many,  many  cases  has  revealed  to  me 
that  with  surprising  regularity  the 
tuberculous    individual,    when    he    or 


10 


Birth  Control 


11 


she  comes  from  a  large  family,  is 
one  of  the  later  born  children — the 
fifth,  sixth,  seventh,  eighth,  ninth, 
etc.  The  explanation  for  this  phe- 
nomenon is  obvious.  When  parents 
are  older,  and  particularly  when  the 
mother  is  worn  out  bv  frequent  preg- 
nancies and  often  weakened  because 
obliged  to  work  in  mill,  factor}^,  or 
workshop  up  to  the  very  da}'  of  con- 
finement, the  child  will  come  into  the 
world  with  lessened  vitality,  its  main 
inheritance  being  a  physiological 
poverty.  This  systemic  poverty  will 
leave  it  less  resistant,  not  only  to 
tu'berculosis  but  to  all  other  diseases 
of  infancy  and  childhood  as  well. 

The  morbidity  and  mortality 
among  these  children  is  gi'eatost 
v.'hen  the  children  are  most  numerous 
in  one  family.  Miss  Emma  Duke,  in 
the  third  of  the  Infant  Mortality 
Series,  gives  the  result  of  a  field 
study  in  Johnstown,  Pa.,  based  on 
the  births  of  one  calendar  year 
(1911).  The  inspection  was  made  in 
1913,  of  the  1911  babies,  so  that  even 
the  last  born  baby  included  had 
reached  its  first  birthday^ — or  rather 
has  had  a  chance  to  reach  its  first 
birthday ;  man}'^  of  them  were  dead 
long  before  that  day.  The  follow- 
ing is  Miss  Duke's  table  showing  the 
infant  mortality  rate  for  all  chil- 
dren borne  by  married  mothers  in 
Johnstown  during  that  year: 

Deaths  per  1,000  births  in 

Families  of  1  and  3  children 108.5 

Families  of  3  and  4  children 136.0 

Families  of  5  and  6  children 153.8 

Families  of  7  and  8  children 176.4 

Families  of  9  and  more  children.  .191.9 

Dr.  Alice  Hamilton  of  the  Memo- 


rial Institute  for  Infectious  Diseases, 

Hull  House,  Chicago,  made  a  study 

of  1,600  families  in  the  neighborhood 

of  the  settlement.     The  following  is 

the  table  of  the  child  mortality  rate 

of  the  1,600  families  as  published  by 

Dr.  Hamilton  :* 

Deaths  per   1,000  l)irtlis  in 

Families  of  4  children  and  less 118 

Families  of   6   children 267 

Families  of  7   children 280 

Families  of  8   children 291 

Families  of  9  children  and  more.... 303 

Many  families  were  found  of  thir- 
teen, fourteen  and  even  sixteen  mem- 
bers. The  largest  of  all  was  that  of 
an  Italian  Woman  who  had  borne 
twenty-two  and  raised  two.  The 
small  families  of  every  nationalitv'^ 
had  a  lower  mortality  rate  than  the 
large  families  of  the  same  national- 
ity. The  Jewish  families  of  four  and 
less  had  the  astonishingly  low  mor- 
tality rate  of  81  per  1,000,  while  in 
families  of  eight  and  less,  the  rate 
rose  to  260  per  1,000. 

The  larger  the  family,  the  more 
congested  w-ill  be<  the  quarters  they 
live  in  and  the  more  unsanitary  wnll 
be  the  environment.  Last,  but  not 
least,  with  the  increase  of  the  family 
there  is  by  no  means  a  corresponding 
increase  of  the  earning  capacity  of 
the  father  or  mother,  and  as  a  result 
malnutrition  and  insufficient  clothing 
enter  as  factors  to  predispose  to 
tuberculosis  or  cause  an  already  ex- 
isting latent  tuberculosis  to  become 
active. 

AVhat  is  the  result  of  this  condition 
in  relation  to  tuberculosis — one  sin- 

*  Bulletin  of  (he  Amer.  Acad,  of  Med.,  May, 
1910,  and  Miss  Mary  Ald.en  Hopkins  in  Harper's 
Weekly. 


12 


Birth  Control 


gle  disease?  Out  of  the  200,000 
individuals  who  die  annually  of  tuber- 
culosis in  the  United  States,  50,000 
are  children.  Of  the  economic  loss 
resulting  from  these  early  deaths  I 
will  speak  later  on,  but  in  continu- 
ing along  the  medical  and  sanitary 
lines  of  my  subject,  I  must  call  your 
attention  to  the  fact  that  according 
to  some  authors  65  per  cent,  of 
women  afflicted  with  tuberculosis, 
even  when  afflicted  onl}^  in  the  rela- 
tively early  and  curable  stages,  die 
as  a  result  of  pregnancy  which  could 
have  been  avoided  and  their  lives  been 
saved  had  they  but  known  the  means 
of  prevention.*  Sometimes  we  suc- 
ceed in  saving  such  a  mother  by  a 
timely  and  careful  emptying  of  the 
uterus.  But  an  abortion  even  scif 
entifically  carried  out  and  only  re- 
sorted to  with  the  view  of  saving  the 
life  of  the  mother,  is  never  desirable, 
cither  for  the  consultant  to  advise, 
nor  for  the  gynecologist  or  obstetri- 
cian to  perform;  and  who  will  dare 
to  say  that  even  under  the  best  con- 
ditions this  operation  is  devoid  of 
danger  ? 

What  Is  the  explanation  and  what 
are  the  consequences  from  the  point 
of  view  of  sanitation,  of  the  death  of 
50,000  tuberculous  children?  They 
have  mostly  become  infected  from  tu- 
berculous parents  or  tuberculous 
boarders  who  had  to  be  taken  into 
the  family  to  help  pay  the  rent.  In 
the  crowded  homes  of  the  poor  there 
was  neither  sunlight,  air,  nor  food 
enough  to  cure  the  sufferers  and  be- 

*  C.    A.    Credi-Hoerder:    "Tuberkulose    und    Mut- 
terschaft^'      CJ.   Kraeger,   Berlin,   1915.) 


fore  they  died  they  became  dissemi- 
nators of  the  disease.  Nearly  all  of 
the  infectious  and  communicable  dis- 
eases are  more  prevalent  in  the  con- 
gested, overcrowded  homes  of  the 
poor,  and  particularly  in  those  of 
large  families.  The  propagation  of 
syphilis  and  gonorrhoea  by  contact 
infection,  other  than  sexual,  can 
sometimes  be  avoided  in  the  homes  of 
the  well-to-do,  b}"  enlightenment  and 
the  conscientiousness  of  the  afflicted. 
They  are  almost  invariably  commu- 
nicated to  the  innocent  in  the  homes 
of  the  ignorant  and  poor.  Gonor- 
rhoeal  infection  from  parent  to  child 
or  from  one  infected  member  of  the 
family  to  the  other,  is  responsible 
more  than  an^^thing  else  for  the  57;- 
272  blind  persons  in  the  United 
States.* 

The  great  syphilographer  Four- 
nier  left  us  the  following  irrefutable 
statistical  evidences  of  the  serious- 
ness of  syphilitic  transmission.  As 
a  result  of  paternal  transmission 
there  is  a  morbidity  of  37.0  per  cent., 
and  a  mortality  of  28.0  per  cent. ; 
maternal  transmission  results  in  84.0 
per  cent,  morbidity  and  60.0  per 
cent,  mortality ;  and  the  combined 
transmissions  are  no  less  than  90.0 
per  cent,  of  morbidity  and  68.5  per 
cent,  mortality.! 

I  venture  to  say  right  here  that 
would  or  could  a  syphilitic  or  gonor- 
rhoeic  parent  be  taught  how  to  pre- 
vent conception  during  the  acute  and 
infectious  stages  of  his  or  her  disease, 
there  would  certainly  be  less  inher- 

*  United    States   Census,    19in. 
t  Berkowitz:     "Late  Congenital  Syphilils."  N.  Y. 
Medical  Journal,   June   17,    1915. 


Birth  Control 


13 


ited  syphilis,  less  blindness  from 
gonorrhoeial  infection ;  -in  other 
words,  less  unfortunate  children  in 
this  world  handicapped  for  life  and 
a  burden  to  the  oonnnunity. 

That  insanity,  idiocy,  epilepsy,  and 
alcoholic  predisposition  are  often 
transmitted  from  parent  to  child  is 
now  universally  admitted,  and  cor- 
roborated 'by  every  day  experience 
and  by  an  abundance  of  statistics. 
Countless  are  the  Inillions  of  dollars 
expended  for  the  maintenance  of 
these  mentally  unfit.  The  State  of 
New  York  alone  spends  $2,000,000 
annually  for  the  care  of  its  insane. 
Whether  sterilization  of  these  indi- 
viduals would  be  the  best  remedy  is 
a  question  still  open  for  discussion. 
The  constitutionality  of  the  proced- 
ure is  doubted  by  some  of  our  legal 
authorities.  Segregation  is  resorted 
to  in  the  meantime  with  more  or  less 
rigor  according  to  the  State  laws. 
Every  year,  however,  many  of  the 
individuals  who  had  been  committed 
to  institutions  for  the  treatment  of 
mental  disorders  are  discharged  as 
cured.  They  are  allowed  to  pro- 
create their  kind.  Would  it  not  be 
an  economic  saving  if  at  least  the 
individuals  whose  intelligence  has 
been  restored  were  instructed  in  the 
prevention  of  bringing  into  the  world 
children  who  are  most  likely  to  be 
mentally  tainted  and  to  become  a 
burden  to  the  community? 

The  economic  loss  to  our  common- 
wealth from  bringing  into  this  world 
thousands  of  children  mentally  and 
physically  crippled  for  life  is  'beyond 
calculation.     But  considering  tuber- 


culosis we  have  been  able  to  calcu- 
late at  least  approximately  what  it 
costs.  I  stated  above  that  50,000 
children  die  annually  from  tubex-cu- 
losis  in  the  United  States.  Figuring 
the  average  length  of  life  of  these 
children  to  be  seven  and  one-half 
years  and  their  cost  to  the  commu- 
nity as  only  $200  per  annum,  repre- 
sents a  loss  of  $75,000,000.  Such 
children  have  died  without  having 
been  able  to  give  any  return  to  their 
parents  or  to  the  community.  Who 
will  dare  to  calculate  in  dollars  and 
cents  the  loss  which  has  accrued  to 
the  community  because  so  many 
mothers  died  of  tuberculosis  when  an 
avoidable  pregnancy  was  added  to  a 
slight  tuberculous  ailment  in  a  cura- 
ble stage.?  Who  will  dare  to  estimate 
the  cost  of  the  loss  of  an  equally 
large  or  perhaps  larger  number  of 
mothers  afflicted  with  serious  cardiac 
or  renal  diseases,  or  frail  or  ill  from 
other  causes,  whose  lives  could  have 
been  prolonged  had  an  additional 
pregnancy  not  ,  aggrevated  their 
condition.'^ 

Of  the  many  mothers,  married  and 
unmarried,  who  have  become  chronic 
invalids  and  even  lost  their  lives  as  a 
result  of  having  resorted  to  abortive 
measures  in  order  to  rid  themselves 
of  an  unwelcome  child,  no  statistics 
are  available.  If  there  were,  they 
would  be  an  appalling  evidence  of  the 
great  danger  of  such  criminal  pro- 
cedures and  would  certainly  show  the 
advantage  of  a  more  enlightened  at- 
titude regarding  the  means  of  con- 
traception, at  least  for  the  married 
women  who  ai-e  enfeebled  or  diseased. 


14 


Birth  Control 


The  many  diseases  I  have  men- 
tioned Avhereby  children  in  large 
families  and  mothers  because  of  too 
frequent  pregnancies  are  carried  off 
to  an  early  grave,  are  not  limited  to 
the  poor.  In  regard  to  economics, 
the  middle  class  suffers  also.  Thus, 
if  even  a  relatively  well-to-do  family 
begins  to  increase  out  of  all  propor- 
tion to  the  earnings  of  the  father, 
the  family  will  soon  be  in  want  and 
approaching  poverty.  Less  and  less 
good  food,  less  sanitary  housing,  less 
care  of  the  children  and  more  sick- 
ness will  almost  inevitably  result. 
Every  sickness  or  death  of  child  or 
adult  has  increased  the  expenses  of 
the  family.  There  is  the  doctor's  bill, 
the  druggist's  bill  and  last  but  not 
least,  that  of  the  undertaker.  A 
grave  had  to  be  purchased.  If  there 
have  been  savings,  they  are  gradu- 
ally swallowed  up  and  debts  are  often 
contracted  for  the  sake  of  a  decent 
funeral. 

Next  to  the  medical  and  sanitary 
comes  the  physiological  aspect  of 
birth  control,  which  can  be  sum- 
marized in  a  very  few  sentences.  The 
average  mother  with  two,  three  or 
four  children,  not  having  arrived  in 
too  rapid  succession,  say  with  two  or 
three  years  intervening,  is  physilogi- 
cally,  that  is  to  say,  physically  and 
mentally,  stronger  and  better 
equipped  to  cope  with  life's  problems 
than  the  worn  out  and  weakened 
mother  whose  life  is  shortened  by  fre- 
quent and  numerous  pregnancies. 

What  is  the  physiological  effect  of 
voluntary  artificial  restriction  of  the 
birth  rate.?     In  Holland,  where  the 


medical  and  legal  professions  have 
openly  approved  and  lielped  to  ex- 
tend artificial  restriction  of  the  birth 
rate,  the  health  of  the  people  at 
large,  as  shown  by  its  general  death 
rate,  has  improved  faster  than  in  any 
other  country  in  the  world.  At  the 
recent  Eugenics  Congress  it  was 
stated  that  the  stature  of  the  Dutch 
people  was  increasing  more  rapidly 
than  that  of  any  other  country — the 
increase  being  no  less  than  four 
inches  within  the  last  fifty  years.  Ac- 
cording to  the  Official  Statistical 
Year  Book  of  the  Netherlands,  the 
proportion  of  young  men  drawn  for 
the  army  over  5  ft.  7  in.  in  height 
has  increased  from  24^/2  to  47^/2  per 
cent,  since  1865,  while  the  proportion 
below  5  ft.  2^  in.  in  height  has  fallen 
from  25  per  cent,  to  under  8  per 
cent.* 

In  that  enlightened  country,  the 
teaching  by  the  medical  profession  of 
the  most  hygienic  methods  of  birth 
limitation  has  enabled  the  poor  to 
have  small  families  which  they  could 
raise  to  be  physically  and  morally 
better  equiped  than  fonnerly.  What 
is  more  interesting  to  observe,  how- 
ever, is  that,  whether  as  a  result  of 
this  or  for  some  other  reason,  the 
families  among  the  well-to-do  are  not 
nearly  as  small  as  in  other  countries. 

In  Australia  and  New  Zealand,  the 
means  of  artificial  control  are  in 
free  circulation  and  the  restriction 
of  families  is  almost  universal.  Yet 
these  two  English  colonies  have  fur- 
nished   to    their   mother    country    in 

*  "The  Small  Family.  System;  Is  It  Injurious  oi 
[mmoral?"  By  Dr.  C.  V.  Drysdale;  Publ.  by 
B.   W.    Huebsch,   New  York. 


Birth  Control 


15 


these  hours  of  struggle  the  most  effi- 
cient, and  physically  and  men  tally 
best  equipped  regiments.  The  sol- 
diers of  Australia  and  New  Zealand 
have  shown  themselves  brave  and 
fearless  fighters  and  certainly  equal, 
if  not  superior,  as  far  as  physical 
endurance  is  concerned,  to  their  Eng- 
lish brethren.  In  the  latter  country, 
it  is  well  known  that  birth  control  is 
frowned  upon  by  the  legal  and  nearly 
all  the  ecclesiastical  authorities. 

And  what  of  France?  Before  the 
present  war  Drysdale,  in  his  "Small 
Family  System,"  very  aptly  says : 
"It  has  become  the  fashion  to  speak 
of  the  depravity  of  France,  of  her 
alcoholism,  of  her  disregard  for  law 
and  order,  and  of  her  terrible  'crimes 
passionels,'  and  to  ascribe  to  them 
the  falling  birth  rate.  If  this  were 
the  case  it  is  obvious  that  these  evils 
would  be  most  intense  where  the 
process  had  gone  furthest,  i.  e.,  in 
the  cantons  of  the  lowest  birth  rate 
(The  French  islands  of  Re  and 
Oleron)."  The  passions  of  the  in- 
habitants of  these  islands  are  very 
innocent.  "They  are  reading  and 
dancing.  The  dancing,  always  de- 
cent, is  the  preparation  for  mar- 
riage; illegitimate  births  ai-^  very 
rare.  One  could  not  imagine  man- 
ners more  pleasant  or  more  honor- 
able. Nevertheless  the  birth  rate  in 
these  islands  is  among  the  lowest.  It 
is  because  everyone  there  is  more  or 
less  of  a  proprietor.  Each  person 
has  some  property  to  protect;  each 
is  ambitious  for  his  children."  But 
w^e  have  the  authority  of  Dr.  Bertil- 
lon,    the    great    French    statistician, 


that  it  is  just  in  the  cantons  of  these 
islands  in  wliich  the  greatest  moral 
improvement  has  taken  place,  and 
that  where  the  French  have  obeyed 
the  command  to  increase  and  multi- 
ply, there  alcoholism  and  crime 
abound. 

Let  me  quote  briefly  from  an 
editorial  on  contraception  which  ap- 
peared in  the  Medical  Times  of  April, 
1916:  "France  to-day  is  presenting 
her  splendid  spectacle  of  utter  effi- 
ciency to  the  world  because  only  the 
'fittest  of  her  people  have  survived, 
and  the  chief  factor  there  has  admit- 
tedly been  contraception.  Surely  we 
have  heard  the  last  of  the  croakers 
about  decadent  France.  Holland 
would  give  an  equally  good  account 
of  herself  if  the  need  should  arise  and 
for  the  same  reason." 

We  have  already  touched  in  part 
on  the  economic  cost  growing  into 
the  millions  which  accrues  annually 
to  the  nation  because  of  a  high  birth 
rate  concomitant  with  a  high  infant 
and  child  mortality  rate.  Well  may 
we  ask  the  question  whether  disease 
and  the  deaths  of  thousands  of 
women  and  children  cannot  be  pre- 
vented by  an  enlightened  attitude 
toward  the  question  of  birth  con- 
trol. Why  is  it  not  done?  If  the 
millions  of  dollars  expended  uselessly 
reverted  to  the  nation's  wealth, 
would  they  not  add  immeasurably  to 
the  health  and  economic  happiness  of 
the  nation  at  large? 

And  now  we  come  to  the  social  or 
sociological  aspect  of  our  topic,  so 
closely  interwoven  with  economics. 
That  the  social  and  moral  life  of  a 


16 


Birth  Control 


smaller  family,  where  the  father 
earns  enough  to  support  wife  and 
children,  where  the  mother  can  de- 
vote her  time  to  the  care  of  them, 
and  where  neither  she  nor  the  chil- 
dren must  go  out  and  help  in  the 
support  of  the  family,  is  superior  to 
that  of  a  famil}^  with  a  large  num- 
ber of  children  where  the  mother  and 
often  the  older  children  must  slave, 
does  not  permit  discussion.  The 
larger  the  family*  of  the  poor  the 
more  child  labor,  the  more  there  is 
disruption  and  irregularity,  and  the 
more  frequentl}'^  one  finds  a  lower 
standard  of  life  and  morals  in 
general. 

The  records  of  our  charities  and 
benevolent  societies  amply  prove  that 
as  a  rule  the  larger  the  families  are 
that  apply  for  relief  the  greater  is 
their  distress. 

In  answer  to  a  letter  from  Dr. 
Foote,  containing  suggestions  on 
this  topic,  the  president  of  the  New- 
York  Association  for  Improving  the 
Condition  of  the  Poor  very  perti- 
nently said: 

"The  race  suicide  theory  which  has 
been  so  much  exploited  of  late,  is 
an  immense  encouragement  to  the 
large  family  idea  and  the  illiterate 
are  hardly  to  be  blamed  if  they  are 
misled  upon  this  question.  The  sub- 
ject that  you  discuss  is  one  that  is 
worthy  of  serious  consideration  and 
that  has  in  the  past  been  treated  with 
an  excess  of  sentiment." 

That  judicious  birth  control  does 
not  mean  race  suicide,  but  on  the 
contrary  race  presei^vation,  may  best 
be  shown  from  the  reports  from  Hol- 


land. The  average  birth  rate  in  the 
three  principal  cities  of  Holland  was 
37.7  per  1,000  in  1881,  when  birth 
control  clinics  were  started.  In 
1912  it  had  fallen  to  25.3  per  1,000. 
The  general  death  rate,  however,  had 
dropped  in  the  same  period  from 
24.2  to  11.1  per  1,000,  or  to  less 
than  half,  while  the  two-thirds  reduc- 
tion in  the  mortality  of  children  un- 
der one  year  of  age — from  209  to  70 
per  1,000  living  births — is  even  more 
significant.* 

As  a  final  evidence  of  the  social 
and  economic  value  of  imparting  in- 
formation concerning  family  limita- 
tion, pennit  me  to  quote  from  a  per- 
sonal letter  to  me  from  the  great  pio- 
neer of  this  humanitarian  movement. 
Dr.  J.  Rutgers,  the  Honorable  Sec- 
retary of  the  Neo-Malthusian  League 
of  The  Hague.  The  league  has  been 
in  existence  since  1888  and  received 
its  legal  sanction  by  a  royal  decree 
January  30,  1895.  It  has  6,000  con- 
tributing members  ;  all  information  is 
given  gratuitously.  As  a  result  of 
this  league  in  Holland  one  does  not 
see  any  children  dressed  in  rags  as 
in  former  years  prior  to  the  starting 
of  this  movement.  To  use  the 
venerable  secretary's  own  words : 
"All  children  you  now  see  are  suit- 
ably dressed,  they  look  now  as  neat 
as  formerly  only  the  children  of  the 
village  clergyman  did.  In  the  fami- 
lies of  the  laborers  there  is  now  a 
better  personal  and  general  hygiene, 
a  finer  moral  and  intellectual  devel- 
opment.     All   this   has   become   pos- 


*  Birth   Control  News,   published   by   Birth    Gon- 
trol  League  of  Ohio,  Cleveland,  Vol.  I,  No.  1. 


Birth  Control 


17 


sible  by  limitation  in  the  number  of 
children  in,  these  families.  It  may  be 
that  now  and  then  this  preventive 
teaching  has  caused  illicit  inter- 
course, but  on  the  whole  morality  is 
now  on  a  nmch  higher  level  and  mer- 
cenary prostitution  with  its  demoral- 
izing- consequences  and  propagation 
of  contagious  disease  is  on  the  de- 
cline. The  best  test  (the  only  pos- 
sible mathematical  test)  of  our 
moral,  physiological  and  financial 
progress,  is  the  constant  increase  m 
longevity  of  our  population.  In  1890 
to  1899  it  was  46.20;  in  1900  to 
1909  it  was  51  years.  Such  rise 
cannot  be  equalled  in  any  other 
country  except  in  Scandinavia  where 
birth  limitation  was  preached  long 
before  it  was  in  Holland.  None  of 
the  dreadful  consequences  antici- 
pated by  the  advocates  of  clericalism, 
militarism  and  conservatism  have  oc- 
curred. In  spite  of  our  low  birth 
rate  the  population  in  our  country 
is  rising  faster  than  ever  before,  sim- 
ply because  it  is  concomitant  with  a 
greater  economic  improvement  and 
better  child  hygiene." 

To  verify  these  figures  statisti- 
cally. Dr.  Rutgers  refers  to  Drys- 
dale's  diagrams.*  The  good  doctor 
closes  his  splendid  letter  by  saying: 
"One  must  have  been  a  family  physi- 
cian for  twenty-five  years  like  myself 
in  a  large  city  (Rotterdam)  to  ap- 
preciate the  blessings  of  conscious 
motherhood    resulting   in    the   better 


*  "Diagrams  of  International  Vital  Statistics 
With  Description  in  English  and  Esperanto,  to- 
gether with  a  Table  of  Correlation  Coefficients 
Between  Birth  and  Death-rates,  etc."  By  C.  V. 
Drysdale,  D.  Sc;  London:  W^m.  Bell,  162  Drury 
Lane,   W.    C,    1912. 


care  of  children,  the  higher  moral 
standard.  And  all  these  blessings 
are  taken  away  from  you  by  your 
government's  peculiar  laws,  made  to 
please  the  Puritans." 

To  these  latter  well-meaning  peo- 
ple and  those  similarly  minded  who 
fear  race  suicide,  particularly  a  de- 
cline of  the  American  stock,  I 
strongly  recommend  the  reading  of 
that  splendid  address  by  Prof.  Chas. 
A.  S.  Read,  A.M.,  M.D.,  fonner 
president  of  the  American  Medical 
Association,  entitled  "The  American 
Family."  In  the  chapter  on  "The 
Outlook  of  the  American  Family" 
he  very  pertinently  says :  "We  see 
in  a  dechning  birth  rate  only  a  nat- 
ural and  evolutional  adjustment  of 
race  to  environment — an  adjustment 
that  insures  rather  than  menaces  the 
perpetuation  of  our  kind  under 
favoring  conditions."  And  concern- 
ing under-population  in  general,  this 
distinguished  writer  says  in  the  same 
address :  "It  seems,  indeed,  to  the 
careful  student  that  the  danger  to 
the  American  family  to-day  and  still 
more  in  the  future  lies  in  the  direc- 
tion of  over-population  rather  than 
under-population. 

According  to  Mulhall  and  Reed, 
the  increase  in  the  density  of  popu- 
lation from  1820  to  1890  was  650 
per  cent,  in  the  United  States  (only 
25  per  cent,  in  the  United  Kingdom 
and  less  than  100  per  cent,  in  France 
and  Belgium).  The  rate  of  increase 
in  this  country  has  been  vastly  accel- 
erated in  the  twenty-five  years  that 
have  since  elapsed.  Our  population 
to-day  of  over  100,000,000  has  been 


18 


Birth  Control 


doubling  itself  on  an  average  of  once 
in  less  than  twenty-five  years  since 
1790,  and.  it  will  probably  continue 
to  do  so  in  the  future.  May  I  say 
in  passing,  that  in  the  State  of  New 
York  we  have  observed  the  alarming 
phenomenon  that  the  proportional 
increase  among  the  insane  is  double 
that  among  the  sane  population? 

And  now  I  approach  the  last  and 
most  important  phase  of  my  subject, 
namely  the  moral,  which  to  me  means 
no  less  than  the  religious  phase  of 
this  great  problem.  Let  me  say  to 
you,  my  colleagues,  that  I  approach 
it  with  awe  and  reverence,  for  I  be- 
lieve I  fully  understand  the  import 
of  it. 

A  quarter  of  a  century  of  practice 
among  the  tuberculous,  the  rich  and 
the  poor,  in  palatial  homes,  humble 
cottages,  dark  and  dreary  tenements, 
and  in  overcrowded  hospitals,  has 
shown  me  enough  to  bring  to  my 
mind  the  utter  immorality  of 
thoughtless  procreation,  and  my  ex- 
perience has  been  limited  to  this  one 
disease  of  the  masses.  The  tears  and 
sufferings  I  have  witnessed  when  I 
have  had  to  decline  help  because  it 
was  too  late  to  prevent  the  despair  of 
the  poor,  frail  mother  at  the  pros- 
pect of  another  inevitable  confine- 
ment, and  later  the  sight  of  a  puny 
babe  destined  to  disease,  poverty,  and 
misery,  has  made  me  take  the  stand 
I  am  taking  to-day.  I  am  doing  it 
after  profound  reflection,  and  I  am 
fully  aware  of  the  opposition  I  am 
bound  to  meet.  But  in  my  early 
career  as  an  anti-tuberculosis  crusa- 
der, I  became  accustomed  to  the  fate 


of  those  who  venture  on  new  and 
heretofore  untrodden  paths  of 
progress. 

What  would  the  moral  outcome  of 
birth  control,  or  let  us  rather  say, 
rational  family  limitation  be,  if 
taught  judiciously  to  those  seeking 
and  needing  the  advice?  Millions  of 
unborn  children  would  be  saved  by 
contraception  from  the  curse  of 
handicapped  existence  as  members  of 
a  family  struggling  with  poverty  or 
disease. 

There  are  hundreds  of  young  men 
and  women,  physically  and  morally 
strong,  who  gladly  would  enter  wed- 
lock if  they  knew  that  they  could 
restrict  their  family  to  such  an  ex- 
tent as  to  raise  few  children  well. 
But  their  fear  of  a  large  family  re- 
tards, if  it  does  not  prevent,  their 
happiness  and  ipso  facto  the  pro- 
creation of  a  better  and  stronger 
manhood  and  womanhood.  The 
woman  withers  away  in  sorrowful 
maidenhood  and  the  man  whose  sex- 
ual instincts  are  often  so  strong  that 
he  cannot  refrain,  seeks  relief  in  asso- 
ciation with  the  unfortunate  and 
often  diseased  sisters,  called  prosti- 
tutes. The  result  is  a  propagation 
of  venereal  diseases  with  all  its  dire 
consequences.  To  an  audience  com- 
posed of  physicians  and  sanitarians 
I  need  not  say  what  these  conse- 
quences are.  They  involve  sterility, 
physical  and  mental  suffering  in  the 
man  or  sterility  in  both  man  and 
woman ;  and  according  to  the  severity 
of  the  infection,  pelvic  disorders, 
abortion,    premature   labor,    a    dead 


Birth  Control 


19 


child  or  one  lastingly  tainted  with 
disease. 

At  times  disease  does  not  enter  as 
a  factor  in  the  tragedy,  but  the  re- 
sult is  a  girl  mother,  a  blasted  life, 
for  our  double  standard  of  morality 
recognizes  only  the  "sin"  in  our  sis- 
ters, not  in  ourselves.  Of  her,  com- 
passionate tongues  only  say  she  loved 
not  wisely  but  too  well ;  of  him,  noth- 
ing is  said  at  all.  He  is  spotless  and 
virtuous  in  the  eyes  of  the  world  and 
can  go  through  life  as  if  he  had  never 
sinned  and  been  responsible  for  a 
blasted  life  or  two. 

Even  our  moralists  must  acknowl- 
edge that  by  an  early  marriage  with 
a  man  of  her  choice,  enabled  by  un- 
derstanding to  limit  the  number  of 
children,  many  a  girl  would  be  saved 
from  so-called  dishonor  and  in  many 
instances  from  prostitution.  One  of 
the  strongest  arguments  of  our  mor- 
alists and  purists  is  that  the  knowl- 
edge of  contraception  would  lead  the 
young  to  enter  forbidden  sexual  rela- 
tions and  degrade  them  morally. 
Granted  that  this  may  happen  in  a 
number  of  instances,  the  benefit  de- 
rived from  a  diminution  of  venereal 
diseases,  from  a  greater  number  of 
happy  and  successful  marriages 
among  the  younger  people,  fewer  but 
better  and  healthier  offspring  instead 
of  an  unrestricted  procreation  of  the 
underfed,  the  tuberculous,  the  alco- 
holics, the  degenerate,  the  feeble- 
minded and  insane  would  more  than 
outweigh  the  isolated  instances  of 
sexual  intercourse  prior  to  marriage. 

I  absolutely  agree  with  our  moral 
teachers  when  they  say  that  self-con- 


ti'ol  is  possible — I  believe  it  to  be 
the  cleanest,  purest,  and  best  pre- 
ventive measure  for  family  limitation 
— 'but  while  it  may  be  easy  for  many 
it  is  not  easy  for  all.  Sociologically 
speaking,  it  is  even  more  difficult 
when  you  deal  with  a  married  couple 
belonging  to  the  poorer  classes  who 
can  not  have  separate  bedrooms. 
Selfcontrol  can  be  more  easily  exer- 
cised prior  to  marriage  than  after- 
wards. 

The  critics  of  birth  control  main- 
tain that  with  the  knowledge  of  birtli 
limitation  many  women,  whether  poor 
or  rich,  w^ho  should  and  can  bear 
children  will  shirk  the  duties  of 
motherhood.  This  I  do  not  believe  to 
be  true.  You  can  no  more  prevent 
the  desire  for  motherhood  in  the  nor- 
mal, healthy  woman  than  you  can 
stem  the  tide  of  the  ocean.  It  is 
inherent  in  every  woman's  heart. 
With  more  marriages  of  young  peo- 
ple and  a  rational  birth  control,  I 
do  believe  there  will  not  be  fewer 
children  but  the  same  number  of  bet- 
ter ones.  There  will  be,  of  course, 
instances — and  there  are  too  many  in 
certain  classes  of  society  now — 
where  for  purely  selfish  reasons  the 
marriage  remains  barren,  but  it  is  a 
question  in  my  mind  whether  it  would 
be  really  desirable  for  society  to  have 
such  women  be  mothers. 

It  has  been  asserted  by  the  same 
critics  that  the  enfeebled,  diseased, 
ignorant  and  poverty  stricken  woman 
in  whose  case  birth  control  might  be 
justified,  will  never  know  about  the 
existence  of  birth  control  clinics.  In 
Holland,    however,    there   must   have 


20 


Birth  Control 


been  some  such  ignorant  women,  yet 
they  seem  to  have  learned  to  avail 
themselves  of  the  service  of  such 
clinics.  Besides,  these  classes  will 
sooner  or  later  come  under  the  ob- 
servation of  some  physician,  either 
privately  or  in  a  hospital.  Some 
opponents  to  the  birth  control  prop- 
aganda say  that  the  measure  advo- 
cated would  not  reach  the  feeble- 
minded, the  idiotic,  half  insane, 
chronic  alcoholics,  and  chronic  crimi- 
nals. This  I  will  grant,  and  steriliza- 
tion of  those  totally  unfit  for  parent- 
hood will  some  day  have  to  become  a 
state  measure,  unless  segregation  is 
resorted  to  more  universally  and 
m,ore  rigorously.  Birth  control  is 
only  one  measure  toward  a  saner  and 
happier  manhood,  womanhood,  and 
childhood. 

Finally,  I  must  mention  the  almost 
pathetic  critcisms  of  some  of  my  col- 
leagues who  wrote  me,  in  answer  to 
my  request  for  an  expression  of  opin- 
ion, that  the  matter  of  birth  control 
was  a  question  not  for  the  medical 
profession,  but  for  the  laity.  To 
such  I  can  only  express  my  regret  at 
their  attitude.  The  physician  of  the 
twentieth  century  who  deals  only 
with  the  purely  medical  and  curative 
part  of  his  profession,  who  is  indif- 
ferent to  measures  to  prevent  disease, 
and  cannot  feel  with  the  social  suf- 
ferings of  the  masses,  is  lacking  in 
the  highest  ideals  of  his  calling  and 
misses  the  greatest  opportunity  of 
benefiting  suffering  mankind. 

After  all  is  said,  I  feel  impelled  to 
plead  with  great  earnestness  for  the 
abolishment  of  the  state  and  federal 


laws  which  make  the  imparting  of 
knowledge  for  contraception  a  crim- 
inal offense.  I  plead  for  the  estab- 
lishment of  graituitous  clinics,  di- 
rected by  regular  physicians  of  high 
repute,  remunerated  by  city  or  state, 
who  are  competent  to  give  informa- 
tion as  to  birth  limitation  in  cases 
where  they  deem  the  giving  of  such 
instructions  advisable. 

Concerning  the  urgency  and  the 
wisdom  of  efforts  to  change  these 
laws,*  1  am  sure  that  you  will  be 
willing  to  listen  to  the  words  of  two 
of  our  greatest  American  physicians  ; 
first,  to  those  of  our  venerable  nestor 
of  the  medical  profession,  Prof.  A. 
Jacobi  of  New  York,  the  ex-presi- 
dent of  the  American  Medical  Asso- 
ciation ;  secondly,  to  Prof.  Hermann 
M.  Biggs  of  New  York,  my  esteemed 
teacher,  the  distinguished  sanitarian 


*  United  States  Criminal  Code;,  Section  211 
(Act  of  March  4,  1909,  Chapter  321,  Section  211, 
U.  S.  Statutes  at  Large,  Vol.  35,  part  1,  page 
1088  et  seq.).  New  York  Statute  Book,  (Section 
1142  of  the  Penal  Law).  The  federal  law  pre- 
scribes a  fine  of  $5,000  or  imprisonment  of  not 
more  than  five  years,  or  both,  for  any  one  using 
the  mails  to  give  advice  for  producing  abortion 
or  preventing  conception.  The  New  York  State 
law,  above  mentioned,,  makes  the  giving  ot  a 
recipe,  drug  or  medicine  for  the  prevention  of 
conception  or  for  causing  unlawful  abortion  a  mis- 
demeanor punishable  with  no  less  than  ten  days 
nor  more  than  one  year  imprisonment  or  a  fine 
of  not  less  than  $50  nor  more  than  $1,000,  or 
both,  fine  and  imprisonment  for  each  offense.  It 
will  be  noticed  that  both  laws  make  the  giving  of 
advice  for  the  prevention  of  conception  as  great  an 
offense  as  producing  abortion.  According  to  the 
New  York  State  law,  a  "lawful"  abortion  is  per- 
mitted and  not  punishable,  but  to  prevent  such 
abortion,  always  more  or  less  dangerous  to  life. 
is  not  permitted  and  punishable  by  law.  In  all 
medical  colleges  careful  instruction  is  given  how 
to  perform  the  "lawful"  abortion.  All  good  text- 
books on  gynecology  describe  the  operation  as 
carefully  as  an  amputation  of  the  cervix  or  a 
hysterectomy;  but  concerning  the  advice  to  give, 
for  example,  to  the  poor  tuberculous  mother  who 
has  had  her  uterus  emptied  once,  so  that  she  may 
not  be  obliged  to  submit  to  such  a  "lawful"  opera- 
tion again,  our  teachers  of  gynecology  and  our 
textbooks  dare  not  say  a  word. 


Birth  Control 


21 


and  pioneer  in  the  modern  warfare 
against  tuberculosis.  In  his  preface 
to  Dr.  William  J.  Robinson's  book 
"The  Limitation  of  Offspring,"  Dr. 
Jaoobi  says :  "Our  federal  and  state 
laws  on  the  subject  of  prevention  of 
conception  are  grievously  wrong  and 
unjust.  It  is  important  that  these 
laws  be  repealed  at  the  earliest  pos- 
sible moment ;  it  is  important  that 
useful  teaching  be  not  crippled,  that 
personal  freedom  be  not  interfered 
with,  that  the  independence  of  mar- 
ried couples  be  protected,  that  fami- 
lies be  safeguarded  in  regard  to 
health  and  comfort,  and  that  the  fu- 
ture children  of  the  nation  be  pre- 
pared for  competent  and  comfortable 
citizenship." 

Dr.  Hermann  M.  Biggs,  prior  to 
the  recent  dismissal  of  the  case  by 
Judge  Dayton  of  the  Federal  Court, 
against  Mrs.  Sanger  for  sending  in- 
formation about  birth  control 
through  the  mails,  gave  to  the  press 
the  following  statement:  "I  am 
strongly  of  the  opinion  that  the  pres- 
ent laws  in  regard  to  the  giving  of 
information  in  relation  to  the  govern- 
ing of  infant  control  are  unwise  and 
should  be  revised.  There  can  be  no 
question  in  the  mind  of  anyone  famil- 
iar with  the  facts  that  the  unre- 
stricted propagation  of  the  mentally 
and  physically  unfit  as  legally  en- 
couraged at  the  present  time  is 
coming  to  be  a  serious  menace  to 
civilization  and  constitutes  a  great 
drain  on  our  economic  resources. 
This  is  my  personal  view." 

To  the  foregoing  expressions  of 
opinions  let  me  add  what  one  of  our 


most  distinguished  jurists,  the  Hon. 
Judge  William  H.  Wadhams  of  the 
Court  of  General  Sessions,  wrote  me 
concerning  these  laws :  "In  order  to 
save  the  state  from  the  burden  of 
large  families,  where  there  is  no  pos- 
sibility of  their  being  supported  and 
where  the  neglect  which  follows  often 
I'esults  in  their  becoming  State 
charges  not  only  because  they  are 
mentally  but  often  physically  unfit  to 
bear  the  burden  of  life,  I  am  of  the 
opinion  that  there  should  be  some 
proper  birth  regulation  after  a  cer- 
tain number  of  children  have  been 
born,  and  that,  therefore,  there 
should  also  be  some  modification  of 
the  laws  with  respect  to  the  giving 
of  information  upon  this  subject.  I 
think  the  sanitary,  medical,  social, 
economic,  and  moral  status  of  the 
population  would  be  improved  by 
proper  and  more  general  information 
upon  this  subject." 

Besides  the  letter  from  this  emi- 
nent judicial  authority  and  the 
strong  expressions 'of  opinion  of  A. 
Jacobi,  M.  D.,  and  Hermann  M. 
Biggs,  M.  D.,  I  have  been  the  recipi- 
ent of  communications  from  many 
leading  physicians,  divines,  political 
economists,  and  sociologists,  all 
agreeing  with  me  that  judicious  birth 
control,  under  the  highest  ethical  and 
medical  guidance,  is  a  national  neces- 
sity and  that  our  present  laws  on  the 
subject  need  urgent  revision.  For 
want  of  space  I  will  mention  only  the 
following:  Dr.  John  N.  Hurty,  sec- 
retary Indiana  State  Board  of 
Health;  Dr.  Godfrey  R.  Pisek,  pro- 
fessor  of  diseases   of   children,   New 


22 


Birth  Control 


York  Post-Graduate  Medical  School 
and  Hospital;  Dr.  J.  W.  Trask  of 
Washington,  D.  C. ;  Dr.  Lydia 
Allen  de  Vilbiss,  formerly  of  the  New 
York  State  Department  of  Health, 
now  in  charge  of  the  division  of  Child 
Hygiene  of  the  State  Board  of  Kan- 
sas ;  Dr.  Ira  S.  Wile,  editor  of 
American  Medicine,  New  York;  Dr. 
John  A.  Wyeth,  professor  of  surgery 
and  president  of  the  New  York 
Polyclinic  Medical  School  and  Hospi- 
tal, ex-president  of  the  American 
Medical  Association  and  New  York 
Academy  of  Medicine ;  Frank  Crane, 
D.  D.,  formerly  pastor  of  the  Union 
Congregational  Church  of  Worces- 
ter, Mass.,  now  well  known  writer  of 
leading  editorial  articles ;  Percy  S. 
Grant,  D.  D.,  rector,  Protestant 
Episcopal  Church  of  the  Association 
of  New  York  City;  Frank  Oliver 
Hall,  D.  D.,  minister  of  the  Church 
of  the  Divine  Paternity,  New  York 
City;  John  Haynes  Holmes,  M.  A., 
Minister,  Unitarian  Church  of  the 
Messiah,  New  York  City ;  Stephen  S. 
Wise,  D.  D.,  Rabbi  of  the  Free  Syna- 
gogue, New  York  City;  James  A. 
Field,  Ph.  D.,  Professor  of  Eco- 
nomics, University  of  Chicago ;  Irv- 
ing Fisher,  Ph.  D.,  professor  of 
political  economy  of  Yale  University 
and  chairman  of  the  Hygiene  Refer- 
ence Board  of  the  Life  Extension 
Institute;  Franklin  H.  Giddings, 
Ph.  D.,  professor  of  political  sci- 
ence, Columbia  University;  William 
H.  Allen,  Ph.  D.,  director  of  the  In- 
stitute for  Pubhc  Service  of  New 
York  City. ;  Hon.  Homer  Folks,  for- 
mer   Commissioner    of    Charities    of 


New  York,  now  secretary  of  the 
State  Charities  Aid  Association  of 
New  York ;  Lillian  D.  Wald,  founder 
of  the  Henry  Street  Settlement  and 
originator  of  the  work  of  the  School 
Nurse  in  New  York;  Prof.  Melvil 
Dewey,  LL.  D.,  educator  and  presi- 
dent of  the  National  Society  for 
Efficiency. 

I  leave  it  to  this  distinguished  body 
of  physicians  and  sanitarians  either 
to  send  a  memorandum  to  the  federal 
and  all  state  governments  setting 
forth  the  reason  for  a  change  of 
these  laws,  or,  if  it  is  thought  wiser, 
to  form  a  committee  to  study  the 
best  and  most  practical  suggestions 
for  federal  or  state  legislatures  to 
act  upon. 

Dr.  William  L.  Holt,  writing  on 
birth  control  as  a  social  necessity  and 
duty,  says :  "Conscious  and  limited 
procreation  is  dictated  by  love  and 
intelligence ;  it  improves  the  race. 
LTnconscious,  irresponsible  procrea- 
tion produces  domestic  misery  and 
half-stai'ved  chldren.  Conscious  pro- 
creation of  human  lives  elevates  man 
to  the  gods.  Unconscious  procrea- 
tion degrades  man  to  the  level  of 
brutes." 

May  I  be  permitted  to  close  with 
what  I  am  free  to  confess  is  my  inner- 
most conviction.''  I  believe  in  birth 
control,  that  is  to  say,  birth  limita- 
tion, based  on  medical,  sanitary, 
highest  ethical,  moral,  and  economic 
reasons.  I  believe  in  it  because  with 
the  aid  of  it  man  and  woman  can 
decide  when  to  have  a  child,  work  and 
prepare  for  its  arrival,  welcome  it  as 
the  fulfilment  of  their  heart's  desire, 


Birth  Control 


23 


watch  over  it,  tenderly  care  for  and 
educate  it,  and  raise  it  to  be  what 
every  child  should  be  destined  to  be — 
a  being  happy,  healthy,  strong  in 
mind,  body,  and  soul.  If  we  but  use 
our  God-given  sense  to  regulate  the 
affairs    of    government    and    family 


wisely  and  economically,  this  great 
world  of  ours  will  be  one  of  plenty 
and  beauty  where  the  good  will  pre- 
dominate over  the  evil  and  the  chil- 
dren born  in  it  will  become  men  and 
women  only  a  little  lower  than  the 
angels — images  of  their  Creator. 


DISCUSSION 


Dr.  Ira  S.  Wii.e,  New  York  City:  In 
reading  the  thoughtful  paper  of  Doctor 
Knopf  a  nnmher  of  thoughts  suggested 
themselves.  Birth  control  is  recognized  to- 
day as  a  factor  in  eugenic  control.  Some 
states  take  cognizance  of  the  advantages  of 
limiting  the  number  of  offspring  in  so  far 
as  defectives  and  criminals  are  concerned. 
The  hiws  of  numerous  states  permitting 
sterilization  or  asexualization  place  the  seal 
of  governmental  approval  upon  the  preven- 
tion of  procreation  in  the  interests  of  the 
public  weal.  Numerous  regulations  provid- 
ing for  the  segregation  of  defectives  repre- 
sent crystallizations  into  law  of  the  principle 
that  the  state  has  a  vital  interest  in  con- 
trolling the  birth  of  certain  types  of  citizens. 
States  requiring  a  certificate  of  health  pre- 
vious to  marriage  point  out  a  deep  interest 
in  the  character  of  health  of  those  who  are 
to  become  parents.  The  underlying  prin- 
ciple is  the  protection  of  the  state  from  the 
development  of  undesirable   children. 

The  law  recognizes  the  interruption  of 
pregnane}'  as  legal  and  justifiable  in  order 
to  save  the  lives  of  women  suffering  from 
tuberculosis,  nephritis,  cardiac  diseases,  or 
from  conditions,  whose  fatal  progress  would 
be  hastened  through  continued  pregnancy, 
but  the  law  holds  it  to  be  illegal  to  teach 
these  same  women  how  to  avoid  conception. 
It  is  manifestly  contrary  to  every  principle 
of  modern  preventive  medicine  that  there 
should  be  such  interference  with  the  judg- 
ment and  action  of  physicians  where  it 
seems  most  rational  and  medically  sound  to 
give  advice  as  to  the  methods  of  preventing 
a  condition  containing  a  hazard  to  life. 

Despite  the  existing  laws,  contraception  is 
practiced  and  undoubtedly  taught  by  mem- 
bers of  the  medical  and  nursing  profession. 


as  well  as  by  midwives.  What  is  equally  im- 
portant is  the  fact  that  contraceptives  are 
sold  in  drug  stores  throughout  the  country 
without  any  interference,  providing  con- 
science is  stretched  and  the  instrumentalities 
are  dispensed  on  the  plea  that  they  are 
agents   for   the   prevention   of   disease. 

It  is  known  that  in  1900  there  were  only 
three-quarters  as  many  living  children  to 
each  1,000  potential  mothers  in  the  United 
States  as  in  1860.  The  reason  for  this  de- 
creased birth-rate  is  undoubtedly  in  a  large 
part  due  to  "the  deliberate  and  voluntary 
avoidance  or  prevention  of  child  bearing  on 
the  part  of  a  steadily  irtcreasing  number  of 
married  people,  who  not  onlv  prefer  to  have 
but  few  children,  but  who  know  how  to 
obtain  their  wash,"  to  quote  the  words  of 
Dr.  John  Shaw  Billings.  At  the  present 
time,  the  practice  of  birth  control  is  more 
or  less  limited  to  the  more  intelligent  part 
of  the  population  and  indeed  to  those  whose 
means  would  most  warrant  the  development 
of  large  families. 

Public  health  sees  in  poverty  its  great 
enemy  and  realizes  that  education  is  its 
most  capable  ally.  The  education  of  poten- 
tial (parents  as  to  the  methods  of  prevent- 
ing conception  may  be  regarded  distinctly 
as  a  public  health  measure.  From  the  stand- 
point of  the  welfare  of  the  race,  those  inter- 
ested in  public  health  measures  are  more 
vitally  interested  in  the  vigor  and  quality  of 
children  born  than  in  their  absolute  numbers. 
The  birth  of  the  most  vigorous  children, 
those  least  susceptible  to  disease,  and  pos- 
sessing the  greatest  chance  of  living  are  the 
particular  types  of  infancy  in  which  health 
officers  should  be  interested.  The  reduction 
of  dysgenic  types  of  ofi"spring  and  the  de- 
crease   of    infants    variously    handicapped, 


24 


Birth  Control 


whose  care-needing  existence  lessens  family 
vitality  represents  a  considerable  part  of  tlie 
public   health   problem. 

The  tremendous  wastage  of  liiiman  life 
resulting  from  stillbirths,  congenital  diseases, 
malformations,  puerperal  injuries  and  in- 
fections, and  economic  pressures  may  be 
partially  offset  by  a  properly  controlled  sys- 
tem of  dissemination  of  information  con- 
cerning the  limitation  of  offspring.  The  old 
doctrine  of  the  survival  of  the  fittest  ha.s 
been  superseded  by  our  more  artificial  and 
humanitarian  program  which  permits  the 
survival  of  even  many  of.  the  weakest  of  the 
infantile  population. 

It  is  well  known  that  the  rate  of  infant 
mortality,  as  pointed  out  in  the  paper  of 
Doctor  Knopf,  increases  with  the  size  of 
the  family.  To  quote  from  Doctor  Hilibs 
in  his  discussion  of  Infant  Mortality:  Its 
Relations  to  Social  and  Industrial  Condi- 
tions, "However  dangerous  'race  suicide' 
and  the  declining  birth-rate  may  he,  there 
can  be  little  doubt  that  excessively  large 
families  is  no  remedy  and  however  desirable 
a  high  rate  of  births  may  be,  it  is  mere 
waste  to  bring  children  into  the  world 
faster  than  the  laws  of  nature  decree  to  be 
desirable."  Race  suicide  is  not  due  to  limit- 
ing the  number  of  births,  but  is  determined 
by  the  ratio  between  births  and  deaths. 
From  the  standpoint  of  public  health,  it  is 
a  greater  degree  of  race  suicide  to  bring 
six  children  into  the  world  and  lose  two  or 
three  than  to  have  two  born  and  reared. 
The  social  consequences  of  large  families 
with  the  accompanying  loss  in  lives  and 
vitality  have  been  suflBciently  described,  so 
that  further  comment  is  unnecessary. 

From  the  standpoint  of  public  health,  it 
is  important  that  a  very  sharp  line  of 
demarcation  should  be  established  between 
abortions  and  the  prevention  of  conception. 
The  interruption  of  pregnancy  to  destroy  a 
developing  ovum  entails  physical  hazards  to 
the  woman  which  often  adds  to  the  mor- 
tality rate.  At  the  same  time  this  is  equally 
the  destruction  of  life  as  foeticide  and,  liter- 
ally speaking,  infanticide.  According  to 
DeLee,  while  abortion  occurs  oftener  among 
the  lower  classes,  criminal  abortion  is  more 
frequent  among  the  more  educated  classes. 

Howard  Kelly  (Medical  Gynecology,  page 
449)  comments  "to  what  extent  the  medical 
profession  is  responsible  for  the  murder  of 


the  unborn"  is  shown  by  the  methods  that 
women  employ  to  induce  abortions  upon 
themselves,  making  use  of  antiseptic  technic 
in  which  tliey  obviously  had  been  instructed. 

The  Report  of  the  Special  Committee  on 
Criminal  Abortions  quoted  in  Textbook  of 
Legal  Medicine  and  Toxicology  (Peterson 
and  Haines,  Volume  II,  page  92)  "estimated 
Ihat  one-third  of  all  pregnancies  throughout 
the  country  end  in  abortions.  This  is  esti- 
mated at  not  less  than  100,000  yearly.  A 
large  number  of  these  are  criminal  abortions 
from  which  the  committee  estimated  that 
6,000  women  die  yearly."  A  fact  of  this 
character  merits  careful  consideration  by  a 
public  health  association  with  a  view  to 
pointing  out  to  the  intelligent  laity  and 
legislators  the  importance  of  differentiating 
between  the  prevention  of  conception,  which 
carries  practically  no  morbidity  and  cer- 
tainly no  mortality,  and  abortion,  which  may 
cause  destruction  of  two  lives. 

Howard  Kelly  in  discussing  syphilis 
(Medical  Gynecology,  page  493)  states  "It 
is  the  recognized  duty  of  all  physicians  in 
the  presence  of  anj^  contagious  disease  to 
protect  others  from  the  risks  of  infection. 
In  the  case  of  syphilis,  wiiere  there  is  a 
question  of  its  introduction  into  marriage, 
tlie  pliysicians'  protective  duty  embraces 
not  only  the  prospective  wife,  but  the  chil- 
dren she  may  bring  into  the  world  and 
through  them  the  interests  of  society."  (Page 
424.)  After  marriage  has  occured  "when 
a  married  man  has  syphilis  the  first  indica- 
tion is  to  prevent  the  contamination  of  his 
wife,  the  second  is  to  guard  against  preg- 
nancy." The  interpretation  of  the  term 
"guarding  against  pregnancy"  opens  up  the 
question  as  to  how  this  is  to  be  accom- 
plished without  violating  existing  laws. 

It  is  urged  that  the  frank  discussion  of 
methods  of  contraception  by  physicians  will 
lead  to  an  increase  of  clandestine  relations 
among  unmarried  girls  by  virtue  of  the 
new  knowledge.  Clandestine  prostitution 
exists  today  and  fear  of  pregnancy  is  not 
an  impassilile  barrier.  The  development  of 
a  conscious  morality,  which  is  the  greatest 
protective  force,  should  not  be  based  upon 
fear.  Admitting  for  the  sake  of  argument 
that  the  same  degree  of  immorality  might 
exist,  there  would  be  at  least  a  decreased 
destruction  of  life  for  the  women  now  ille- 
gitimately   pregnant    and    the    fetus    to    be 


Birth  Control 


25 


destroyed.  Fewer  homes  would  suffer  dis- 
grace, foundlings  would  decrease  in  number, 
while  an  accursed  bastardy  would  be  greatly 
diminished. 

I  do  not  advocate  however  that  knowl- 
edge concerning  the  prevention  ni  concep- 
tion should  be  given  to  the  young,  but  merely 
to  adults  and  only  to  those  who  are  wedded. 
It  cannot  be  denied  that  a  law  of  this  char- 
acter would  undoubtedly  be  broken  ju.st  as 
is  the  present  law  today.  The  transmission 
of  some  facts  with  reference  to  contracep- 
tion is  constantly  going  on,  but  they  eman- 
ate from  polluted  sources  and  reflect  folk 
lore  rather  than  intelligent  medical  opinion. 

I  do  not  favor  the  abolition  of  federal  or 
state  laws  which  deal  with  abortions,  though 
owing  to  the  weight  of  public  opinion  con- 
victions for  violations  of  these  laws  are 
remarkably  limited  in  view  of  the  large 
number  of  violations  occurring  annually.  I 
believe  and  would  urge  that  the  federal  and 
state  laws  be  amended  so  that  in  effect  the 
procuring  of  an  abortion  and  the  preventing 
of  conception  will  be  dissociated  as  acts 
not  synonymous  in  character  and  meriting 
entirely  different  treatment.  The  procuring 
of  an  abortion  should  still  be  penalized.  The 
prevention  of  conception  should  be  per- 
mitted. The  New  York  State  law  links  pre- 
vention of  conception  and  unlawful  abor- 
tion, thus  indicating  the  legality  of  certaiit 
types  of  abortion. 

Because  the  state  already  recognizes  its 
right  to  limit  procreation  among  certain 
groups  of  the  population,  because  the  de- 
crease in  the  birth-rate  will  result  in  im- 
proved public  health  and  the  social  economic 
improvement  of  the  masses  of  this  country, 
because  prevention  of  conception  would  add 
to  the  health  and  racial  betterment  of  the 
nation,  I  believe  that  the  American  Public 
Health  Association  should  take  a  stand  upon 
the  subject  of  limitation  of  offspring.  To 
this  end,  I  urge  that  resolutions  be  passed 
favoring  the  amendment  of  federal  and  state 
laws,  so  that  the  words  preventing  or  pre- 
vention of  conception  be  eliminated  there- 
from. 

Db.  J.  H.  Landis,  Health  Officer,  Cin- 
cinnati, Ohio:  It  goes  without  saying  that 
we  are  all  in  favor  of  reducing  the  number 
of  those  who  are  physically,  mentally,  and 
morally  unfit  and  adding  to  the  number  of 
those  who  are  physicallj'  fit,  mentally  sound 
and  more  highly  developed  morally. 


The  paper  brings  to  our  attention  a  num- 
ber of  facts  that  have  long  Ijeen  recognized 
as  true.  No  one  will  deny  that  the  off- 
spring of  a  tuberculous  mother  has  a  poorer 
chance  of  living  than  one  from  a  mother 
without  a  wasting  disease  or  that  the  healthy 
mother  has  a  better  chance  of  surviving 
pregnancy  than  has  her  diseased  sister. 

No  one  doubts  that  infant  mortality  is 
greatest  among  the  offsprings  of  the  ignor- 
ant, the  poor,  the  undcj^/ed  and  badly 
housed,  the  tuberculous,  the  degenerate,  the 
alcoholic,  the  vicious  and  the  mentally  de- 
fective. 

Congestion  and  lack  of  air  and  sunshine 
have  long  been  recognized  as  powerful  pre- 
disposing factors  in  the  dissemination  of 
disease  and  death  among  those  exposed. 

The  remedy  suggested  for  all  of  these 
conditions  is  birth  control.  The  remedy  is 
directed  towards  the  effects  produced  in- 
stead of  being  directed  at  the  causes  pro- 
ducing  them. 

I  am  unable  to  see  how  birth  control  is  to 
solve  the  problems  created  by  vice,  poverty, 
ignorance  and  alcoholism  while  these  con- 
ditions go  on  unchecked,  and  am  unwilling 
to  believe  that  the  size  of  the  family  has 
anything  to  do  with  any  of  them  with  the 
possible  exception  of  poverty. 

The  pride  and  glory  of  the  medical  pro- 
fessiion  is  bound  up  in  the  word  ''preven- 
tion." Humanity  owes  us  a  far  greater  debt 
for  sickness  prevented  than  for  sickness 
cured. 

A  multitude  of  causes  are  responsible  for 
the  high  tuberculosis  rates  that  prevail.  The 
disease  is  one  of  the  most  contagious  with 
which  we  have  to  deal.  Nature's  favorite 
method  of  removing  the  unfit,  from  any 
cause,  is  by  the  tuberculosis  route. 

The  control  of  tuberculosis  involves  all  of 
the  factors  active  in  producing  individuals 
who  are  rendered  susceptible  by  these  fac- 
tors, the  quarantining  of  those  who  are 
spreading  the  disease  and  the  care  of  those 
other  members  of  the  family  rendered  de- 
pendent. Birth  control  can  play  only  a 
minor  role  in  the  control  of  this  disease. 

Birth  control  will  not  enlighten  the  ignor- 
ant, render  the  poverty-stricken  affluent^ 
transform  the  alcoholic  into  a  total  ab- 
stainer, make  the  vicious  virtuous,  or  re- 
move the  cloud  from  the  brain  of  the  men- 
tally defective. 


26 


Birth  Control 


Definite  causes  are  combining  to  produce 
tliese  results  and  the  logical  point  of  attack 
is  the  combination  of  causes. 

The  ignorant  can  be  educated;  the  poor 
made  more  thrifty;  the  vicious  forcibly  re- 
strained; and  the  mentally  defective  ren- 
dered incapable  of  reproducing  their  kind. 

The  prevalence  of  typhoid  fever  is  an 
index  to  the  purity  of  a  community's  water 
and  milk  supply.  Filtration  of  water  and 
pasteurization  tf  milk  have  solved  the 
typhoid  fever  problem  in  those  communities 
in  which  they  have  been  efficiently  carried 
on. 

Vice,  crime,  tuberculosis,  poverty,  degen- 
eracy, alcoholism,  ignorance  and  feeble- 
mindedness are  as  distinctly  due  to  particu- 
lar preventive  causes  as  typhoid  fever  is 
to  impure  water  and  milk,  and  it  appears 
to  me  that  birth  control  would  be  as  impo- 
tent to  control  the  first  set  of  conditions  as 
it  would  be  to  control  typhoid  fever. 

Dissemination  of  the  knowledge  of  birth 
control  would,  in  my  humble  judgment,  de- 
crease the  number  of  fit  and  increase  the 
number  of  unfit  for  the  reason  that  the 
knowledge  would  be  applied  by  those  capa- 
ble of  producing  normal  children  and 
ignored  by  those  unfit  individuals  who  are 
under  the  guidance  and  control  of  the  most 
powerful  primal  instinct. 

Dr.  J.  N.  HuBTY,  Indianapolis,  Ind.:  We, 
tne  people,  are  suffering  from  many  delu- 
sions. Nearly  everj'one  entertains  the  delu- 
sion that  they  can  violate  the  laws  of  nature, 
abuse  their  bodies,  bring  on  disease  and 
degeneracy,  and  then  find  repair  in  a  medi- 
cine. It  is  a  fool  idea,  yet  it  is  very  general. 
There  are  other  delusions.  There  is  only 
one  way  to  improve  the  human  race,  and 
that  is  the  natural  way.  The  first  high 
point  of  interest  in  the  paper  is  when  Doctor 
Knopf  says:  "My  appeal  is  not  a  plea  for 
reducing  the  population  but  for  increasing 
its  vigor  by  reducing  the  number  of  the 
physically,  mentally,  and  morally  unfit  and 
adding  to  the  number  of  the  physically 
strong,  mentally  sound,  and  higher  morally 
developed  men  and  women."  Certainly  no 
one  on  any  score  can  object  to  this.  The 
idea  is  practical,  pure  and  lofty.  If  general 
birth  control  will  help  it  onward,  even  a 
little  bit,  then  I  am  for  general  birth  con- 
trol. I  suppose  no  one  would  advocate  the 
raising    of    idiots    or    physically    deformed 


people,  yet  when  it  is  proposed  not  to  raise 
them,  through  the  practical  application  of 
sterilization  or  segregation,  up  goes  a  howl 
from  the  prudes  which  is  of  a  character 
likely  to  provoke  emesis.  It  is  important 
and  interesting  to  learn  that  when  tuber- 
culosis appears  in  a  large  family,  it  is  gen- 
erally nunabers  5,  6,  7,  8  or  9  of  the  children 
that  are  stricken.  This  is  indeed  significant, 
and  I  believe  it  to  be  true.  When  I  read 
this  in  Doctor  Knopf's  paper  I  made  some 
inquiries  of  two  men  who  have  done  a  great 
deal  of  tuberculosis  work,  and  they  con- 
firmed it  and  said  they  believed  it  was  true. 
Again,  Miss  Duke's  Johnstown  figures  speak 
loudly  against  families  of  above  four  chil- 
dren. For  a  pair  to  have  more  is  generally 
to  invite  sickness,  invalidism  and  deatli, 
and  if  we  will  stop  to  think  and  look  around 
among  the  prosperous,  great  and  strong 
people  as  a  rule  (of  course  there  are  ex- 
ceptions) they  do  not  have  families  of  more 
than  four  and  generally  about  two.  I  do 
not  believe  that  this  condition  has  been 
brought  about  by  continence.  Surely  preg- 
nancy is  contra-indicated  in  a  tuberculosis 
woman  unless  it  is  desirable  to  kill  her  and 
add  to  the  number  of  pitiful  motherless 
babies.  A  husband  who  cannot  be  conti- 
nent with  a  tuberculous  wife  is  a  sorry 
specimen  of  manhood  and  truly  such  speci- 
mens are  many.  And  here  I  think  it  proper 
to  say  that  birth  control  will  not  likely  ever 
be  a  resultant  of  voluntary  continence.  Like 
education  and  monogamy,  it  must  be  forced 
upon  most  of  the  animals  we  call  men.  An 
important  point  made  by  Doctor  Knopf  is, 
"would  or  eould  a  syphilitic  or  gonorrhoeic 
parent  know  how  to  prevent  conception  dur- 
ing the  acute  and  infectious  stages  of  his  or 
her  disease,  there  would  certainly  be  less 
of  congenital  syphilis,  less  blindness  from 
gonorrhoeal  infection."  If  these  ends  can 
be  gained,  even  in  slight  degree,  by  birth 
control,  I'm  for  it  strong.  I  remember  the 
doctor  in  "Damaged  Goods"  says:  "It  is 
better  to  have  fifty  soimd  and  whole  men 
than  to  have  a  hundred,  sixty  or  seventy 
of  whom  are  more  or  less  rotten." 

That  is  an  important  interrogatory  in  the 
paper  which  reads^ — -"What  is  the  physio- 
logical effect  of  voluntary  artificial  restric- 
tion of  the  birth-rate  of  the  offspring?" 
The  answer  is  satisfactory,  for  the  reports 
from  Holland,  where  the  medical  profes- 
sion  have   openly   approved   and   helped   to 


Birth  Control 


27 


extend  artificial  restriction,  are  to  the  effect 
that  the  niorliidity  and  niorlality  rates' iiave 
improved  more  rapidly  tiiaii  in  <jther  coun- 
tries. Holland  also  supplies  data  to  prove 
that  rational  birth  control  docs  not  mean 
race  suicide,  l)ut  on  the  contrary,  race  ]ires- 
ervation  and  strengthening.  Doctor  Holt, 
as  quoted  by  Doctor  Knopf,  talks  wisely 
when  he  sajs — "Conscious  and  liiriited  pro- 
creation is  dictated  by  love  and  intelligence; 
it  improves  the  race.  Unconscious,  irre- 
sponsible procreation  produces  domestic 
misery  and  half-starved  children.  Conscious 
procreation  of  human  lives  elevates  man  to 
the  gods;  unconscious  proci-eation  degrades 
man  to  the  level  of  brutes."  It  is  plain  tliat 
Doctor  Knopf  has  contended  and  written 
well.  Conscientiousness  in  his  contention  is 
apparent.  I  am  sure  good  will  follow  his 
effort. 

Dr.  W.  L.  Holt:  I  should  like  to  call  your 
attention  to  tlie  fact  that  we  as  a  nation, 
like  all  the  civilized  nations,  are  already 
practicing  birth  control;  but  in  a  very 
stupid  and  mistaken  way.  N<amely  just  that 
part  of  the  population  which  is  called  "the 
upper  class,"  which  is  undoubtedly  superior 
physically  and  mentallj'  as  well  as  finan- 
cially and  accordingly  produces  the  most 
desirable  children  and  ought  to  produce  at 
least  its  share  of  the  future  generation,  is 
practicing  birth  control  to  such  an  extent 
that  the  old  families  are  dying  out;  whereas 
the  inferior  part  of  our  population,  which 
is  also  financially  least  able  to  raise  four 
children,  is  raising  four  and  more.  What 
could  be  more   stupid? 

Dr.  Louis  I.  Dublin,  New  York  City: 
The  other  day  I  contributed  a  paper  in 
another  section  on  the  commoner  errors  in 
statistical  work.  I  wish  I  had  had  Doctor 
Knopf's  paper  at  my  disposal,  for  I  could 
have  used  it  very  profitably  for  my  text. 
I  do  not  recall  any  paper  that  I  have  read 
for  some  time  that  is  more  subject  to  criti- 
cism on  the  score  of  method  than  the  paper 
we  have  just  heard.  I  believe  it  is  funda- 
mentally erroneous  because  of  the  emo- 
tional attitude  of  the  writer  which  has 
caused  him  to  draw  general  conclusions  from 
an  examination  of  only  a  very  limited  part 
of  his  subject.  His  emphasis  is  entirely  in 
the  wrong  place.  There  is  altogether  too 
much  birth  control  now  and  what  the  com- 
munity needs  is  emphasis  on  birth  release 


by   the   healthy,  capable  and  self-respecting 
elements  of  the  comnumity. 

There  is  time  only  for  one  word  and  I 
want  to  limit  that  to  the  story  of  France. 
In  France,  we  have  today  a  sorry  spectacle 
of  the  results  of  birth  control.  The  lesson  is 
obvious.  France  is  today  crying  for  men; 
for  men  wlio  were  either  not  txirn  or  died 
at  an  alarming  rate  in  infancy  or  later  of 
tuberculosis.  The  attitude  of  mind  which 
is  engendered  by  •  a  nation-wide  policy  of 
birth  control  ultimately  brings  about  more 
infant  mortality  and  more  tuberculosis  be- 
cause of  the  general  weakening  of  the  stock 
which   directly   results   therefrom. 

A  Member:  It  strikes  me  that  the  whole 
question  resolves  itself  into  who  should 
marry  and  who  sliould  not  marry.  Unless 
we  have  some  laws  regulating  marriage,  to 
teach  young  men  and  young  women  the  na- 
ture of  the  social  diseases  and  the  conditions 
necessary  for  a  good  physical  body,  why, 
we  will  have  tulserculosis,  we  will  have  de- 
generates, we  will  have  idiots  and  imbeciles 
and  our  penitentiaries  and  almshouses  and 
every  other  penal  institution  will  be  filled. 
The  whole  question  is  prevention;  I  believe 
strictly  in  the  doctrine  of  heredity.  Hered- 
ity, environment  and  education  is  the  tri- 
angle that  leads  to  greatness.  If  we  do  not 
hover  around  those  three  points,  we  will 
never  succeed.  We  know  that  if  two  de- 
generates marrj^  they  beget  degenerate  chil- 
dren, beget  imbeciles.  If  an  imbecile  mar- 
ries a  normal  person,  half  of  the  children 
will  be  imbeciles  or  degenerates,  and  we 
have  the  records  of  criminality  and  all  those 
deficiencies  and  the  penalty  is  the  result  of 
improper  marriage.  Teach  the  laws  of  na- 
ture and  our  mothers  will  demand  that  their 
daughters  don't  marry  a  man  who  has  in 
his  veins  the  virus  of  a  venereal  disease 
circulating  through  his  body. 

Dr.  John  W.  Trask,  United  States  Public 
Health  Service,  Washington,  D.  C:  The 
subject  may  be  approached  from  a  number 
of  different  angles.  During  the  discussion 
a  thought  has  occurred  to  me  which  may 
be  worth  presenting.  WHiat  is  the  cominoB 
reason  for  wanting  the  population  to  grow? 
What  is  at  the  bottom  of  the  more  or  less 
prevalent  idea  that  it  is  meritorious-  to  be 
the  parent  of  many  children?  It  has  oc- 
curred to  me  while  sitting  here  that  cham- 
bers of  commerce  and  boards  of  trade  want 


28 


Birth  Control 


the  populations  of  their  respective  cities  to 
increase — tlie  faster,  the  better — because  it 
is  to  their  interest  to  have  more  individuals 
to  sell  things  to,  more  individuals  to  whom 
they  can  sell  dry  goods,  clothing,  and  gro- 
ceries, more  individuals  to  whom  to  sell 
houses  and  land.  The  greater  the  popula- 
tion the  more  business  will  be  done  and  the 
greater  the  increase  in  the  value  of  real 
estate.  On  the  other  hand,  those  interested 
in  affairs  of  state  may  want  the  population 
of  their  coimtry  to  grow  that  there  may  be 
a  larger  group  from  which  to  draw  an  army 
for  purposes  of  defence  or  perhaps  offence. 
Birth  control  is  opposed  in  a  way  to  the 
interests  of  business  and  of  the  holders  of 
real  estate.  Nor  will  it  be  the  best  national 
policj'  where  a  growing  population  and  large 
armies  are  necessary  as  a  protection  against 
invasion  or  oppression  by  lawless  peoples. 
However,  it  would  seem  at  least  worthy  of 
consideration  whether  the  best  conditions 
would  not  be  attained  by  families  commen- 
surate in  size  with  the  household  incomes 
and  by  nations  commensurate  in  population 
with  their  areas,  economic  conditions  and 
natural  resources.  Better  people,  living 
cleaner,  healthier  and  more  rational  lives, 
and  not  more  people,  would  seem  to  be  the 
logical  objective. 

Dr.  Kkopf:*  My  first  duty  is  of  course 
to  thank  you  all  for  the  very  kind  atten- 
tion you  have  given  to  my  paper  on  a  rather 
unusual  and,  in  some  circles,  rather  unpopu- 
lar subject.  It  shows  that  you  have  come 
here  determined  to  listen  and  then  to  judge 
— -to  accept  my  ideas,  to  reject  them,  or 
to  suspend  judgment. 

Dr,  Ira  S.  Wile  agrees  with  me  so  thor- 
oughly that  I  see  very  little  reason  to  take 
up  time  in  referring  to  his  paper,  except 
to  thank  him  for  his  cooperation  and  par- 
ticularly for  the  strong  opinion  he  has  ex- 
pressed concerning  the  urgent  need  of  rec- 
ommending an  amendment  of  the  federal 
and  state  laws  to  the  effect  that  the  pro- 
curing of  an  abortion  and  the  prevention 
of  conception  will  be  disassociated,  and 
considered  as  acts  meriting  entirely  differ- 
ent treatment.  We  all  agree  that  produc- 
ing an  abortion  for  no  other  reason  than  to 
rid  a  healthy  mother  of  an  unwelcome  child 
is  a  crime  and  should  continue  to  be  con- 
sidered as  such. 


*  This  discussion  has  been  revised  and  enlarged 
since  its  presentation. — Editor. 


Doctor  Landis'  paper  is  a  little  surprising 
to  me.  When  the  doctor  says  in  today's  dis- 
cussion that  birth  control  will  not  do  away 
with  our  social  evils,  will  not  render  the 
poverty  stricken  affluent,  transform  the  alco- 
holic into  a  total  abstainer,  nor  remove  the 
cloud  from  a  mentally  defective,  he  is  but 
partially  right.  Birth  control  has  enlight- 
ened the  ignorant  in  Holland  nnd  has  ren- 
dered the  poverty  stricken  not  affluent  but 
economically  more  comfortable;  it  has  de- 
creased crime,  immorality,  and  illegitimacy. 
At  the  same  time,  I  do  not  for  a  moment 
think  that  birth  control  alone  will  do  away 
with  the  procreation  of  the  feeble-minded, 
idiotic,  half  insane,  chronic  alcoholics,  or 
chronic  criminals.  Birth  control  is  not  a 
panacea  for  all  the  ills  of  society,  it  is  only 
one  measure  toward  a  saner  and  happier 
man-,  woman-,  and  childhood.  To  minimize 
the  harm  to  society  and  to  future  genera- 
tions produced  by  the  just  mentioned  class 
of  unfortunates,  the  state  should  step  in 
and  demand  medical  examination  of  both 
the  prospective  father  and  mother,  prior  to 
granting  them  a  marriage  license.  Even 
with  our  present  limited  but  growing  knowl- 
edge of  the  laws  of  heredity,  we  should  be 
able  to  prevent  many  of  the  evidently  imfit 
from  becoming  parents  and  save  many  a 
chUd  of  tomorrow  from  a.  handicapped  ex- 
istence— a  burden   to  himself  and  others. 

As  already  indicated  in  my  paper,  there 
is  a  certain  class  so  mentally  and  physically 
diseased  that  sterilization,  or  at  least  segre- 
gation, must  be  resorted  to.  Doctor  Landis 
i§  absolutely  right  when  he  says  that  "A 
multitude  of  causes  are  responsible  for  the 
high  tuberculosis  rates  that  prevail."  If  I 
did  not  think  that,  would  I  have  devoted 
twenty-five  of  the  best  years  of  my  life  to 
the  combat  of  tuberculosis?  Bad  housing 
conditions,  bad  factory  hygiene,  overcrowded 
and  unhygienic  schools,  useless  studies  and 
not  enough  outdoor  play  for  the  children, 
child  labor,  ignorance  on  the  part  of  the 
laity,  the  late  diagnosis  of  the  disease  on 
the  part  of  the  profession,  failure  of  ra- 
tional treatment  and  lack  of  institutions, 
are  some  of  the  multiple  causes  responsible 
for  the  high  tuberculosis  morbidity  and  mor- 
tality rate. 

Those  of  my  colleagues  who  have  honored 
me  by  their  steadfast  friendship  and  con- 
stant cooperation  will  bear  me  out  when  I 
say   that   I   have   done   my  best   to   help   to 


Birth  Control 


29 


remove  these  causes  during  years  of  con- 
scientious labor. 

I  have  approached  the  subject. of  birth 
control  after  deep  reflection  and  with  the 
saine  earnestne.ss  and  zeal  I  am  devoting 
to  my  tuberculosis  work,  and  with  due 
reverence  for  all  that  is  sacred  in  man's 
physical,  moral,  and  religious  life.  I  now 
believe  in  it  with  all  the  sincerity  and  earn- 
estness I  am  capable  of.  I  believe  in  it  be- 
cause by  its  aid  there  will  rise  a  generation 
of  men,  physically,  mentally,  and  morally 
fit,  and  children  free  from  disease  andpife- 
pared  to  take  up  the  struggle  for  life. 

I  must  revert  oinoe  more  to  my  friend. 
Doctor  Landis'  discussion  of  the  tubercu- 
losis problem.  I  said  he  was  absolutely  right 
in  the  statement  that  a  multitude  of  causes 
were  responsible  for  the  high  tuberculosis 
death  rates  that  prevail.  But  I  say  with  equal 
emphashis  that  he  is  absolutely  wrong  when 
he  says  in  the  following  sentence  that  "the 
disease  is  one  of  the  most  contagious  with 
which  we  have  to  deal."  It  is  not  the  most 
but  the  least  contagious  and  should  always 
be  classed  with  communicable  diseases.  It 
should  not  be  considered  as  most  contagious 
like  smallpox  for  example.  On  the  contrary, 
strictly  speaking,  it  is  not  contagious  at  all. 
The  word  contagious  comes  from  the  Latin 
contingere,  "to  touch,"  but  the  touch  of  the 
honest,  conscientious,  and  clean  consumptive 
is  no  more  contagious  than  that  of  a  healthy 
person.  This  can  hardly  be  said  of  the 
smallpox  patient,  be  he  ever  so  clean.  It 
is  best  for  an  unvaccinated  individual  never 
to  touch  him,  and  still  better  to  stay  away 
from  him  as  far  as  possible. 

I  would  consider  it  a  most  regrettable 
thing  if  it  should  go  out  to  the  public  that 
a  distinguished  member  of  the  American 
Public  Health  Association  has  suddenly  de- 
clared tuberculosis  to  be  the  most  con- 
tagious of  diseases.  We  have  already  too 
much  phthisiophobia  which  makes  ±he  lot 
of  the  unfortunate  consumptives  hard 
enough. 

For  the  kindly  words  said  by  my  good 
friend,  Doctor  Hurty,  I  am  deeply  grateful. 
He  is  always  progressive,  fearless,  and  out- 
spoken. He  agrees  with  me  so  thoroughly 
that  I  feel  he  will  do  his  share  toward  a 
better  understanding  of  the  problem  under 
consideration  and  be  an  enthusiastic  sup- 
porter  of   the   all   important   movement   for 


the  betterment  of  mankind,  which  he  loves 
.so  much. 

To  the  member  whose  name  I  could  not 
catch  and  who  maintained  that  the  whole 
question  resolves  itself  into  who  should 
marry  and  who  .should  not  marry,  I  wish  to 
say  that  it  was  merely  for  lack  of  time  that 
I  did  not  touch  on  this  subject  in  my  paper. 
That  I  strongly  advocate  a  medical  exami- 
nation of  the  man  as  well  as  the  woman 
prior  to  granting  a  marriage  license,  I  have 
already  said  in  my  reply  to  Doctor  Landis' 
criticisms.  Much  unhappiness  and  misery 
could  be  avoided  by  such  obligatory  exami- 
nation and  if  we  could  add  to  our  institu- 
tions of  learning  a  school  of  parenthood 
with  obligatory  attendance  for  every  (Mie 
desiring  to  enter  the  matrimonial  state,  we 
would  add  still  more  to  the  happiness  and 
prosperity  of  the  individual  and  the  com- 
munity at  large. 

Now  a  M'ord  to  our  Catholic  friends  and 
those  of  other  faiths  who  are  so  strongly 
opposed  to  contraception  and  limiting  family 
increase.  Let  us  have  no  word  of  bitter- 
ness or  reproach  because  millions  of  devout 
Catholics  hold  these  views.  Let  us  not  an- 
tagonize either  the  Catholic  priest  or  lay- 
man, who  have  a  right  to  their  con%ictions 
as  much  as  we  have  to  ours.  This  is  a 
purely  scientific  meeting,  composed  of  men 
who  should  not  have,  and  I  hope  do  not 
have,  any  hatred  in  their  heart  because  of 
differences  of  opinion  regarding  religious 
views.  Therefore,  in  reply  to  the  somewhat 
passionate  remarks  of  the  distinguished  sta- 
tistician of  the  Metropolitan  Life  Insurance 
Company  who  questions  the  accuracy  of  my 
statistics  and  my  statements,  and  says  that 
it  is  all  fundamentally  erroneous,  I  vnsh  to 
reply  wth  less  vehemence.  I  would  calmly 
state  that  if  we  do  not  believe  in  oflBcial 
statistics  of  one  kind,  we  cannot  believe  in 
official  statistics  of  another  kind.  Mine  were 
prepared  by  the  government  in  Holland  and 
by  the  United  States  government  and  offi- 
cials of  various  cities.  The  gentleman  makes 
the  statement  that  because  of  my  emotional 
attitude  toward  the  question  of  birth  con- 
trol, my  conclusions  are  fundamentally  erro- 
neous and  drawn  from  an  examination  of 
only  a  very  limited  part  of  my  subject. 
Mr.  Dublin  is  not  a  physician;  he  is  a  Doctor 
of  Philosophy,  and  this  perhaps  is  an  ex- 
cuse for  finding  fault  with  my  emotional 
attitude.     My  experience  as  a  physician  has 


30 


Birth  Control 


brought  me  into  contact  not  only  with  the 
happ3'  and  well-to-do  but  also  with  the 
poverty  stricken  and  the  mentally  and 
morally  diseased,  with  the  unfortunate  girl- 
mother  and  our  unfortunate  sister  the  so- 
called  prostitute,  and  last  bnt  not  least, 
with  the  honest  but  poor  and  ignorant 
mother  of  a  large  family  who  is  a  sla\'e  by 
day  and  by  night.  It  has  been  my  earnest  de- 
sare  to  lessen  tlie  misery  caused  by  thoughtless 
procreation,  and  I  may  perhaps  be  forgiven 
if  I  have  approached  the  subject  with  deep 
conviction  and  not  without  emotion.  'We 
physicians  cannot,  and  God  forbid  that  we 
ever  shall,  deal  merelj^  with  cold  figures 
and  statistical  facts.  We  love  science,  yes, 
and  accuracy  in  science  and  statistics,  but 
this  does  not  prevent  us  from  feeling  witli 
our  parents  in  their  sufferings  of  mind, 
body,  or  soul. 

I  do  not  at  all  disagree  with  the  gentle- 
man when  he  speaks  of  birth  release  by 
the  healthy  and  well-to-do.  In  my  paper 
I  have  referred  to  this  and  also  believe  to 
have  distinctly  shown  that  I  do  not  plead 
for  race  suicide  but  most  emphatically  for 
race  preservation  and  multiplication  of  the 
best  and  noblest,  physically,  mentally,  and 
morally.  What  I  think  of  France  of  today, 
I  have  already  said,  and  when  the  gentle- 
man says  that  France  is  crying  for  more 
men,  I  might  first  say  that  the  quality  of 
the  French  soldiers  has  made  up  for  the 
quantity.  Russia  has  had  and  has  the  most 
men.  It  does  not  cry  for  more  men,  and 
still  its  achievements  do  not  compare,  at 
least  not  up  to  this  day,  with  the  achieve- 
ments of  France. 

La.stly,  when  Dr.  Dublin  says:  "The  atti- 
tude of  mind  which  is  engendered  by  a 
nation-wide  policy  of  birth  control,  brings 
about  more  infant  mortality  and  more 
tuberculosis  because  of  the  general  weaken- 
ing of  the  stock  which  directly  results  there- 
from," I  most  thoroughly  disagree  with  this 
argument.  My  personal  statistics  regarding 
the  frequency  of  tuberculosis  among  the 
later  born  children  in  large  families  have 
been,  as  you  have  heard,  corroborated  by 
Dr.  Hurty's  investigations;  and  all  physi- 
cians know  that  women,  particularly  those 
of  the  working  classes  when  worn  out  by 
frequent  pregnancies,  are  more  subject  to 
tuberculosis  thin  almost  any  other  class  of 
people.  How  then  can  Dr.  Dublin  believe 
that    birth    limitation     would     cause    more 


tuberculosis?  In  Russia,  where  the.  word 
birth  control  is  unknown,  tuberculosis  and 
infant  mortality  are  the  highest  of  all  civil- 
ized countries.  On  the  other  hand,  in  Hol- 
land, where  we  might  speak  of  nation-wide 
birth  control,  as  already  stated  in  my  paper, 
after  forty  years  of  this  policy  there  is  less 
infant  mortality,  an  increase  in  population, 
a  better  physique,  and  a  higher  morality. 
Furthermore,  there  has  not  been  a  general 
weakening  but  a  general  improvement  in 
the  strength  of  the  stock  which  is  shown 
by  an  increase  in  stature  and  increase  in 
^he  longevity  of  the  population  at  large. 

My  good  friend,  Assistant  Surgeon-Gen- 
eral John  W.  Trask,  has  admirably  answered 
Ihe  question  as  to  what,  aside  of  the  war 
and  its  demands  for  more  men,  is  the  com- 
mon reason  for  wanting  the  population  to 
grow.  It  is  a  splendid  answer  and  I  could 
not  possibl_v  improve  on  it  but  -wish  to 
thank  him  most  heartily  for  what  he  said, 
but  I  wish  to  go  a  step  further  by  saying 
I  feel  now  more  than  ever  convinced  that 
the  over-population  of  Germany  has  been 
one  of  the  vital  causes  of  this  disastrous 
war  which  has  lirought  so  much  misery  to 
all  humanity.  Prof.  Robert  J.  Sprague,  of 
the  Massachusetts  Agricultural  College,  ex- 
pressed this  view  very  strongly  the  other 
day  at  the  meeting  of  the  Genetic  Associa- 
tion when  he  said:  "The  barbaric  birth-rate 
of  Germany  hemmed  in  as  she  is  b.y  the 
other  nations,  made  the  great  war  inevitable 
and  will,  if  it  keeps  up,  make  war  foi-ever 
in  the  future.  Some  believe  this  will  work 
eugenically  for  the  survival  and  predomi- 
nance of  the  strongest  and  best  race,  but 
this  is  still  a  mooted  question.  The  survival 
of  the  merely  strong  may  result  in  the  sur- 
vival of  the  strong  animal.  Pressure  of 
population  on  subsistence  and  area  develops 
brutality,  selfishness,  and  disregard  of 
human  life.  It  crushes  leisure,  generosity, 
and  art  and  makes  impossible  some  of  the 
finest  virtues  of  the  race.' 

I  have  already  said  how  anxious  I  am 
tliat  we  may  treat  this  subject  as  a  scien- 
tific one  and  that  we  should  only  have  in 
view  the  iiighest  ideal,  namely,  a  normal 
imcrcase  of  population  concomitant  with 
our  resources  and  an  improvement  of  the 
quality  of  our  population ;  in  other  words, 
we  should  strive  to  render  the  lives  of  man, 
woman,   and   child   more   healthy  and   more 


Birth  Control 


31 


happy,  and  economically  secure.  My  per- 
sonal belief  is  that  we  shall  thereby  become 
more  highly  developed  spiritually  and  ap- 
proach more  rapidly  towards  the  millennium. 
When  at  last  an  enlightened  government 
will  permit  contraception  to  be  taught  wliere 
it  is  likely  to  be  productive  of  the  most 
good,  when  in  years  to  come  we  can  show 
our  Catholic  brethren  and  all  those  who 
oppose  us  now  that  because  of  judicious 
birth  control  resulting  in  a  rational  family 
limitation,  we  have  decreased  poverty,  dis- 
ease, and  crime  and  have  produced  a  better 
generation  of  men  and  women,  better 
equipped  for  life's  mission,  in  short,  men 
worthy  to  be  called  true  citizens  of  a  great 
republic,  then  I  am  sure  our  Catholic 
friends  and  other  opponents  will  see  that 
after  all  we  have  not  been  so  wrong  and 
they  may  then  be  willing  to  follow  along 
the  same  lines  of  teaching  rational  birth 
control. 

I  have  been  asked  why  I  became  inter- 
ested in  birth  control  so  suddenly,  which 
is  apparently  so  foreign  to  my  specialty, 
but  I  can  assure  you  that  while  I  have 
taken  up  the  work  only  recently,  my  inter- 
est was  not  sudden  at  all.  As  already 
stated,^  it  began  many  j'ears  ago  in  con- 
nection with  my  work  in  the  tenements  and 
overcrr,wded  hospitals  where  I  witnessed  the 
sufi'erings  of  many  a  tuberculous  mother 
whom  1  could  not  help  because  it  was  too 
late  to  prevent.  The  despair  of  some  poor, 
frail  creature  at  the  prospect  of  another 
inevitable  confinement,  the  likelihood  of 
her  early  decease  as  a  result  of  this  newly 
added  pregnancy,  the  thought  of  her  other 
children  who  would  be  deprived  of  a 
mother's  care  at  ages  when  they  need  it 
most,  and  later  the  sight  of  a  puny  babe 
destined  to  disease,  poverty,  and  misery, 
opened  my  eyes  to  the  utter  immorality  of 
thoughtless  procreation,  not  only  of  the 
tubercvilous,  but  of  all  others  physically  and 
mentally  diseased  and  impoverished. 

Nature's  forces  are  blind.  She  creates 
without  thought  of  provision  for  the  off- 
spring. Think  of  bacterial  life  if  it  had 
remained  unchecked  by  the  genius  of  a  Pas- 
teur, a  Koch,  a  Lister;  of  the  insects,  such 
as  the  yellow  fever  and  malaria-spreading 
mosquitoes,  if  unchecked  by  a  Reed  and  a 
Gorgas !  I  could  continue  the  theme  of 
man's   triumph  and  control   over  nature  in- 


definitely if  I  were  to  enter  into  the  field 
of  agricultural  and  industrial  science.  I 
could  tell  you  of  the  battles  of  the  Aus- 
tralian farmer  with  the  rapidly  multiplying 
rabbit.  Here  nature's  blind  tendency  to 
procreate  devastated  the  fields  destined  to 
nourish  the  population. 

The  excessive  birth  rate  of  human  beings 
in  India  and  China  is  to  my  mind  also 
largely  responsible  for  the  frequent  famines 
and  their  sequellse  of  pestilence,  plagues, 
etc.  The  idea  that  there  is  and  always  will 
be  enough  room  and  food  for  all  mankind 
on  this  earth,  no  matter  how  great  the  in- 
crease in  population,  is,  to  say  the  least, 
erroneous.  In  my  address  I  have  already 
referred  to  the  work  of  Doctor  Reed,  who 
says,  "It  seems,  indeed,  to  the  careful  stu- 
dent that  the  danger  to  the  American  fam- 
ily to-day  and  still  more  in  the  future  lies 
in  the  direction  of  overpopulation  rather 
than  underpopulation." 

Is  there  no  danger  at  all  in  this  country 
of  ours  of  a  possible  famine  due  to  over- 
population and  underproduction  of  food 
substances?  In  his  forthcoming  book  on 
Food  Problems  (Goodhue  &  Co.,  Publ.,  New 
York),  of  which  I  had  the  privilege  to  see 
the  proof,  my  friend.  Dr.  Henry  Smith 
Williams,  the  well  knov.m  physician  and 
economist,  makes  the  following  statement: 
"In  the  census  period  1900-1910,  the  popu- 
lation of  the  United  States  increased  by  21 
per  cent.,  but  the  production  of  cereal  grain 
increased  by  only  1.7  per  cent.  In  the  mean- 
time there  has  been  such  a  falling  ofP  in  the 
animal  industry  that  there  would  have  been 
required  60,000,000  more  meat  animals  (cat- 
tle and  sheep)  on  the  hoof  in  order  that 
meat  should  have  been  as  abundant  per 
capita   as  it  was   in    1890." 

This  authoritative  statement  should  give 
serious  food  for  thought  to  statesmen  and 
sociologists,  as  well  as  to  us  physicians.  The 
difference  between  the  increase  in  produc- 
tion and  population  is  too  great  even  at 
this  time  for  family  limitation  alone  to 
prevent  food  problems  becoming  intensified 
from  year  to  year.  There  must  be  very 
soon  a  wiser  distribution  of  wealth  and 
population,  that  is  to  say,  more  social  jus- 
tice for  all — man,  woman  and  child — ^and  a 
return  to  the  field  of  some  of  the  masses 
through  making  farming  more  profitable. 
Besides  taxing  unimproved  property  in  and 


32 


Birth  Control 


around  cities  or  utilizing  it  for  the  public 
good  or  temporary  cultivation,  there  should 
be  an  intensive  cultivation  of  the  vast  areas 
as  yet  unused.  A  steady  decrease  in  the 
food  supply  will  not  only  lead  ultimately  to 
famine  but  prior  to  that  will  increase  tuber- 
culosis and  other  diseases  of  malnutrition 
to  an  alarming  degree,  as  is  demonstrated 
at  this  time  in  the  warring  countries  of 
Europe.  In  order  to  thrive  physically, 
mentally,  and  morally,  man  must  have  room. 
Overpopulation  and  overcrowding  is  injuri- 
ous to  man,  beast,  and  plant.  Profe'ssor 
Spraguc,  whom  I  have  already  referred  to, 
is  right  when  he  says:  "Man  has  learned 
that  corn  and  potatoes  must  be  given  proper 
spacing  lest  Mother  Earth  be  crowded  and 
they  do  not  grow  well,  but  he  has  often 
forgotten  to  place  sufficient  spacing  be- 
tween his  human  children  that  they  might 
develop  to  the  highest." 


If  non-interference  with  thoughtless  na- 
ture comprises  one  of  the  tenets  of  the  re- 
ligion of  others,  to  me  man's  intellectual 
control  over  nature's  blind  forces  and  na- 
ture's thoughtless  procreation  of  undesirable 
bacterial,  insect,  or  animal  life,  and  his 
powers  to  bring  forth  more  useful  products 
and  make  life  for  man,  woman,  and  child 
not  only  more  bearable  but  even  more  beau- 
tiful and  glorious,  are  among  the  greatest 
proofs  of  the  existence  of  God's  power  in 
man.  But  the  greatest  of  all  achievements, 
the  most  divine  gift  which  god  has  bestowed 
upon  man,  is  conscious  procreation.  To  me, 
.j^icious  birth  control  under  the  guidance 
af  the  best  and  ablest  among  our  own  pro- 
fession, among  the  clergy  and  the  sociolo- 
gists, based  on  tlie  highest  conception  of 
sanitary,  medical,  moral,  ethical,  and  eco- 
nomic reasons,  can  well  be  considered  a 
spiritual  asset  which  will  uplift  the  race. 


The  Cp-Operative  Press,  15  Spruce  Street,  New  York 


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